Provider Demographics
NPI:1780097014
Name:O'HALLORAN, PATRICIA E
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:E
Last Name:O'HALLORAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PATRICA
Other - Middle Name:E
Other - Last Name:INVERGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 S LAKE PARK AVE
Mailing Address - Street 2:MANAGED CARE DEPARTMENT
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-6638
Mailing Address - Country:US
Mailing Address - Phone:219-947-6113
Mailing Address - Fax:219-947-6503
Practice Address - Street 1:901 MACARTHUR BLVD
Practice Address - Street 2:AUDIOLOGY DEPARTMENT
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2901
Practice Address - Country:US
Practice Address - Phone:219-836-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002073A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist