Provider Demographics
NPI:1871508630
Name:VARVIL, TERRY A (NBC-HIS)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:A
Last Name:VARVIL
Suffix:
Gender:M
Credentials:NBC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2463 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-1039
Mailing Address - Country:US
Mailing Address - Phone:618-519-9304
Mailing Address - Fax:618-519-9305
Practice Address - Street 1:2463 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1039
Practice Address - Country:US
Practice Address - Phone:618-519-9304
Practice Address - Fax:618-519-9305
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2385237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist