Provider Demographics
NPI:1851619878
Name:DIVELBISS, JOHN R (HIS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:DIVELBISS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 OAKWOOD MALL DR
Mailing Address - Street 2:STE. 202
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3858
Mailing Address - Country:US
Mailing Address - Phone:715-514-4380
Mailing Address - Fax:715-514-5138
Practice Address - Street 1:3610 OAKWOOD MALL DR
Practice Address - Street 2:STE. 202
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3858
Practice Address - Country:US
Practice Address - Phone:715-514-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-14
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1338-060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist