Provider Demographics
NPI:1649292988
Name:SMEKRUD, PAMELA K (CCC)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:K
Last Name:SMEKRUD
Suffix:
Gender:F
Credentials:CCC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:KAY
Other - Last Name:PRUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC
Mailing Address - Street 1:27790 W HIGHWAY 22 STE 27
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-2396
Mailing Address - Country:US
Mailing Address - Phone:847-649-6000
Mailing Address - Fax:847-649-6060
Practice Address - Street 1:27790 W HIGHWAY 22 STE 27
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-2396
Practice Address - Country:US
Practice Address - Phone:847-649-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000564231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK29701214660Medicare PIN
P72873Medicare UPIN
IL203361Medicare PIN