Provider Demographics
NPI:1972797512
Name:WAKABAYASHI, MIDORI (AUD)
Entity type:Individual
Prefix:
First Name:MIDORI
Middle Name:
Last Name:WAKABAYASHI
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CHESTNUT ST
Mailing Address - Street 2:SIXTH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4216
Mailing Address - Country:US
Mailing Address - Phone:215-955-6784
Mailing Address - Fax:215-923-4532
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:SIXTH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:215-955-6784
Practice Address - Fax:215-923-4532
Is Sole Proprietor?:No
Enumeration Date:2007-08-28
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT005963231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist