Provider Demographics
NPI:1487722948
Name:REESE, ALLEN EDWARD (HEARING AID DEALER)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:EDWARD
Last Name:REESE
Suffix:
Gender:M
Credentials:HEARING AID DEALER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 N. MICHIGAN ST.
Mailing Address - Street 2:SUITE C
Mailing Address - City:PLYMOUTH
Mailing Address - State:IN
Mailing Address - Zip Code:46563
Mailing Address - Country:US
Mailing Address - Phone:574-936-8878
Mailing Address - Fax:574-936-8878
Practice Address - Street 1:322 N. MICHIGAN ST.
Practice Address - Street 2:SUITE C
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563
Practice Address - Country:US
Practice Address - Phone:574-936-8878
Practice Address - Fax:574-936-8878
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17000229237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN351758227Medicaid