Provider Demographics
NPI:1881612091
Name:FARNHAM, TODD ALAN (AUD, CCC-A)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ALAN
Last Name:FARNHAM
Suffix:
Gender:M
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 FOX RUN PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-5371
Mailing Address - Country:US
Mailing Address - Phone:605-665-0062
Mailing Address - Fax:605-665-0076
Practice Address - Street 1:2525 FOX RUN PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-5371
Practice Address - Country:US
Practice Address - Phone:605-665-0062
Practice Address - Fax:605-665-0076
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD006A237600000X
NE673237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025372000Medicaid
NE203OtherAUDIOLOGIST
NE10025369000Medicaid
NE673OtherHA DISPENSER
SD006AOtherAUDIOLOGIST
NE10025369000Medicaid
NE10025372000Medicaid