Healthcare Provider Details

I. General information

NPI: 1396782280
Provider Name (Legal Business Name): JULIE PABST M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10021 DUPONT CIRCLE CT
FORT WAYNE IN
46825-1604
US

IV. Provider business mailing address

2700 W HIGGINS RD SUITE 120
HOFFMAN ESTATES IL
60169-2006
US

V. Phone/Fax

Practice location:
  • Phone: 260-426-8117
  • Fax: 260-420-0817
Mailing address:
  • Phone: 847-843-1900
  • Fax: 517-843-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002799A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: