Healthcare Provider Details

I. General information

NPI: 1972101889
Provider Name (Legal Business Name): KATRINA LAPHAM AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 E ONTARIO ST STE 1100
CHICAGO IL
60611-2818
US

IV. Provider business mailing address

73 E LAKE ST APT 4005
CHICAGO IL
60601-4802
US

V. Phone/Fax

Practice location:
  • Phone: 312-263-7171
  • Fax:
Mailing address:
  • Phone: 207-322-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001799
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: