Provider Demographics
NPI:1205016912
Name:CHIRILLO, PATRICIA KB (MS)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:KB
Last Name:CHIRILLO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10425 W NORTH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-2416
Mailing Address - Country:US
Mailing Address - Phone:414-607-1830
Mailing Address - Fax:414-607-0127
Practice Address - Street 1:10425 W NORTH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-2416
Practice Address - Country:US
Practice Address - Phone:414-607-1830
Practice Address - Fax:414-607-0127
Is Sole Proprietor?:No
Enumeration Date:2007-11-09
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI73-156231H00000X, 237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41130300Medicaid
WIK400321372Medicare PIN