Provider Demographics
NPI:1619266756
Name:UNRUH, PERRY WALLACE (MS, CCC-A)
Entity Type:Individual
Prefix:MR
First Name:PERRY
Middle Name:WALLACE
Last Name:UNRUH
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:MR
Other - First Name:PERRY
Other - Middle Name:WALLACE
Other - Last Name:UNRUH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, CCC-A
Mailing Address - Street 1:147 W BADILLO ST STE B
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2016
Mailing Address - Country:US
Mailing Address - Phone:626-858-6333
Mailing Address - Fax:
Practice Address - Street 1:147 W BADILLO ST STE B
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2016
Practice Address - Country:US
Practice Address - Phone:626-858-6333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU1012237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter