Provider Demographics
NPI:1295438646
Name:WACHOB, DRUCELLA
Entity type:Individual
Prefix:
First Name:DRUCELLA
Middle Name:
Last Name:WACHOB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4123
Mailing Address - Country:US
Mailing Address - Phone:812-243-4622
Mailing Address - Fax:800-524-8107
Practice Address - Street 1:859 COLONIAL RD SW
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2446
Practice Address - Country:US
Practice Address - Phone:276-623-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101002667237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist