Healthcare Provider Details

I. General information

NPI: 1972603470
Provider Name (Legal Business Name): DESIRAE L VOBR MA, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 S MAIN ST
WINNER SD
57580-1794
US

IV. Provider business mailing address

417 S MAIN ST
WINNER SD
57580-1794
US

V. Phone/Fax

Practice location:
  • Phone: 605-842-1209
  • Fax:
Mailing address:
  • Phone: 605-842-1209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number312A
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: