Healthcare Provider Details

I. General information

NPI: 1992147631
Provider Name (Legal Business Name): ZACHARY SCOTT LA FRATTA AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 CLINIC DR
WEST LAFAYETTE IN
47907-2122
US

IV. Provider business mailing address

715 CLINIC DR
WEST LAFAYETTE IN
47907-2122
US

V. Phone/Fax

Practice location:
  • Phone: 765-494-4229
  • Fax:
Mailing address:
  • Phone: 765-494-6842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: