Provider Demographics
NPI:1386782308
Name:FROMM, URSULA T (BC-HIS)
Entity type:Individual
Prefix:
First Name:URSULA
Middle Name:T
Last Name:FROMM
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9669 KENTON AVE
Mailing Address - Street 2:SUITE 605
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1248
Mailing Address - Country:US
Mailing Address - Phone:847-675-4201
Mailing Address - Fax:773-539-6250
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1248
Practice Address - Country:US
Practice Address - Phone:847-675-4201
Practice Address - Fax:773-539-6250
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1333237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist