Provider Demographics
NPI:1982853743
Name:DEHAAN, WILLIAM III (BC-HIS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DEHAAN
Suffix:III
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1062 EAGLERIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2130
Mailing Address - Country:US
Mailing Address - Phone:719-569-5000
Mailing Address - Fax:
Practice Address - Street 1:1062 EAGLERIDGE BLVD
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2130
Practice Address - Country:US
Practice Address - Phone:719-569-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO149237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist