Provider Demographics
NPI:1609498914
Name:PERRODIN, DAVID P (SLP)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:PERRODIN
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 WINNEBAGO AVE
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1230
Mailing Address - Country:US
Mailing Address - Phone:608-617-4486
Mailing Address - Fax:
Practice Address - Street 1:450 WINNEBAGO AVE
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-1230
Practice Address - Country:US
Practice Address - Phone:608-617-4486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist