Provider Demographics
NPI:1053610055
Name:SPECIALIZED AUDIOLOGY SERVICES PC
Entity type:Organization
Organization Name:SPECIALIZED AUDIOLOGY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF AUDIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:REGET
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:773-543-8121
Mailing Address - Street 1:350 S NORTHWEST HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4262
Mailing Address - Country:US
Mailing Address - Phone:773-543-8121
Mailing Address - Fax:773-321-0193
Practice Address - Street 1:350 S NORTHWEST HWY STE 300
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-4262
Practice Address - Country:US
Practice Address - Phone:773-543-8121
Practice Address - Fax:773-321-0193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-17
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000880231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL357648455001Medicaid
1598984007OtherPERSONAL NPI NUMBER