Wallace Center for Hearing, LLC

Primary specialty

AudiologistTaxonomy code 231H00000X

Legal business name

WALLACE CENTER FOR HEARING, LLC

Practice address

4127 Progress Blvd
Peru, IL 61354-1112

Phone

(815) 223-3201

Fax

(815) 223-3202

NPI assigned

Oct 1, 2021

Last updated

Aug 28, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Beth Ann Wallace, M.S.NPI 1871846204

Title

Audiologist

Phone

(815) 233-3201

Specialties & licenses 1

Addresses

Other names 1

• Wallace Center for Hearing, LLC Former legal business name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Beth Ann Wallace, M.S.

  • Audiologist
  • Peru, IL
  • NPI 1871846204
  Medicare reassignment Care Compare group NPD Authorized official
• Madison Rae Sudaj, AU.D.

  • Audiologist
  • Rockford, IL
  • NPI 1437880804
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693180800000",
    "number": "1700558467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3436 E 325TH RD",
            "city": "LA SALLE",
            "state": "IL",
            "postal_code": "613019734",
            "telephone_number": "815-866-2084"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4127 PROGRESS BLVD",
            "city": "PERU",
            "state": "IL",
            "postal_code": "613541112",
            "telephone_number": "815-223-3201",
            "fax_number": "815-223-3202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE CENTER FOR HEARING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2023-08-28",
        "certification_date": "2023-08-28",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "AUDIOLOGIST",
        "authorized_official_telephone_number": "815-233-3201",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M.S."
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wallace Center for Hearing, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Wallace Center for Hearing, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Audiologist in Peru, IL
• Providers in Peru, IL by specialty
• Audiologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.