NPI 1053399345 · live from the CMS NPI Registry
Steven C Bourgeois, MA, CCC-A
Audiologist in Great Lakes, IL. National Provider Identifier 1053399345, active.
NPI record
| NPI | 1053399345 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Audiologist 231H00000X |
| Practice location | 1020 11th Ave, Great Lakes, IL 60088 |
| Practice phone | 847-688-5568 |
| Mailing address | 2026 Oak Tree Trl, Lake Villa, IL 60046 |
| Enumerated | January 6, 2006 |
| Last updated | July 8, 2007 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Audiologist primary | 231H00000X | AUD003412 (GA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.