Provider Demographics
NPI:1265024053
Name:LAMM, EDDIE (HIS)
Entity type:Individual
Prefix:
First Name:EDDIE
Middle Name:
Last Name:LAMM
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 1:801 NW 13TH ST
Mailing Address - Street 2:
Mailing Address - City:FRUITLAND
Mailing Address - State:ID
Mailing Address - Zip Code:83619-2316
Mailing Address - Country:US
Mailing Address - Phone:208-452-2592
Mailing Address - Fax:
Practice Address - Street 1:801 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:FRUITLAND
Practice Address - State:ID
Practice Address - Zip Code:83619-2316
Practice Address - Country:US
Practice Address - Phone:208-452-2592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY214237700000X
ID9161671237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID9161671OtherDIVISION OF OCCUPATIONAL AND PROFESSIONAL LICENSES
WY214OtherWYOMING BOARD OF HEARING INSTRUMENT SPECIALIST