Provider Demographics
NPI:1265754279
Name:UNION PROFESSIONAL HEARING CENTER, LLC
Entity type:Organization
Organization Name:UNION PROFESSIONAL HEARING CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MODROSIC
Authorized Official - Suffix:
Authorized Official - Credentials:MS, F-AAA
Authorized Official - Phone:636-583-4902
Mailing Address - Street 1:427 JANE AVE
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:MO
Mailing Address - Zip Code:63084-1907
Mailing Address - Country:US
Mailing Address - Phone:636-583-4902
Mailing Address - Fax:636-583-4925
Practice Address - Street 1:427 JANE AVE
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:MO
Practice Address - Zip Code:63084-1907
Practice Address - Country:US
Practice Address - Phone:636-583-4902
Practice Address - Fax:636-583-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002021117231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty