Provider Demographics
NPI:1740694710
Name:PHAM, PERRINE (AUD)
Entity type:Individual
Prefix:
First Name:PERRINE
Middle Name:
Last Name:PHAM
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 1:637 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2159
Mailing Address - Country:US
Mailing Address - Phone:630-618-2519
Mailing Address - Fax:
Practice Address - Street 1:3434 NW 56TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4488
Practice Address - Country:US
Practice Address - Phone:630-232-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001474231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist