Provider Demographics
NPI:1417483173
Name:RHODES, JOSHUA DAVID (HIS)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:DAVID
Last Name:RHODES
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 219
Mailing Address - Street 2:
Mailing Address - City:BROOKPORT
Mailing Address - State:IL
Mailing Address - Zip Code:62910-0219
Mailing Address - Country:US
Mailing Address - Phone:618-564-2558
Mailing Address - Fax:618-551-2830
Practice Address - Street 1:202 E 2ND ST
Practice Address - Street 2:
Practice Address - City:BROOKPORT
Practice Address - State:IL
Practice Address - Zip Code:62910-2884
Practice Address - Country:US
Practice Address - Phone:618-564-2558
Practice Address - Fax:618-551-2830
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101868237700000X
IL2944237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist