Provider Demographics
NPI:1023517091
Name:PROFESSIONAL HEARING ASSOCIATES LLC
Entity type:Organization
Organization Name:PROFESSIONAL HEARING ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:DR
Authorized Official - First Name:COLDORE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HOPPER
Authorized Official - Suffix:IV
Authorized Official - Credentials:AUD FAAA
Authorized Official - Phone:618-466-4444
Mailing Address - Street 1:1344 DADRIAN PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:GODFREY
Mailing Address - State:IL
Mailing Address - Zip Code:62035-1685
Mailing Address - Country:US
Mailing Address - Phone:618-466-4444
Mailing Address - Fax:618-466-4444
Practice Address - Street 1:1344 DADRIAN PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:GODFREY
Practice Address - State:IL
Practice Address - Zip Code:62035-1685
Practice Address - Country:US
Practice Address - Phone:618-466-4444
Practice Address - Fax:618-466-4444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PROFESSIONAL HEARING ASSOCIATES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-06
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000829231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty