Provider Demographics
NPI:1497543730
Name:HEARING CLINICS OF WISCONSIN, LLC
Entity type:Organization
Organization Name:HEARING CLINICS OF WISCONSIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUDIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:414-690-4333
Mailing Address - Street 1:5793 W GRANDE MARKET DR STE N
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7017
Mailing Address - Country:US
Mailing Address - Phone:920-738-1819
Mailing Address - Fax:
Practice Address - Street 1:5793 W GRANDE MARKET DR STE N
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7017
Practice Address - Country:US
Practice Address - Phone:920-738-1819
Practice Address - Fax:920-694-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-28
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100042501Medicaid