Provider Demographics
NPI:1962657734
Name:DELORIER, JOSEPH R
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:R
Last Name:DELORIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-4362
Mailing Address - Country:US
Mailing Address - Phone:847-888-0663
Mailing Address - Fax:847-888-2967
Practice Address - Street 1:1015 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-4362
Practice Address - Country:US
Practice Address - Phone:847-888-0663
Practice Address - Fax:847-888-2967
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-20
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147.000365237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter