Provider Demographics
NPI:1689742579
Name:SEIKEL, JOHN ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANTHONY
Last Name:SEIKEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 W MCNABB RD
Mailing Address - Street 2:
Mailing Address - City:INKOM
Mailing Address - State:ID
Mailing Address - Zip Code:83245-1502
Mailing Address - Country:US
Mailing Address - Phone:208-775-3183
Mailing Address - Fax:
Practice Address - Street 1:638 E. DUNN ST.
Practice Address - Street 2:IDAHO STATE UNIVERSITY
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-8116
Practice Address - Country:US
Practice Address - Phone:208-282-4037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1185235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist