Provider Demographics
NPI:1972101889
Name:LAPHAM, KATRINA (AUD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:LAPHAM
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 E LAKE ST APT 4005
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-4802
Mailing Address - Country:US
Mailing Address - Phone:207-322-9990
Mailing Address - Fax:
Practice Address - Street 1:142 E ONTARIO ST STE 1100
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2818
Practice Address - Country:US
Practice Address - Phone:312-263-7171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001799231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist