Provider Demographics
NPI:1053196360
Name:DOCTORS OF HEARING HEALTHCARE EAST, LLC
Entity type:Organization
Organization Name:DOCTORS OF HEARING HEALTHCARE EAST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:TACKABERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-509-9898
Mailing Address - Street 1:435 N MULFORD RD STE 10
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5100
Mailing Address - Country:US
Mailing Address - Phone:181-539-9527
Mailing Address - Fax:815-399-3764
Practice Address - Street 1:5063 SHORELINE RD
Practice Address - Street 2:
Practice Address - City:LAKE BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1700
Practice Address - Country:US
Practice Address - Phone:847-382-6010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAWRENCE CLAYTON & ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty