Provider Demographics
NPI:1982434684
Name:WAMPLER, PAUL (HIS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WAMPLER
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 1:380 N TERRA COTTA RD STE B
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60012-1809
Mailing Address - Country:US
Mailing Address - Phone:815-893-6777
Mailing Address - Fax:815-893-6764
Practice Address - Street 1:380 N TERRA COTTA RD STE B
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60012-1809
Practice Address - Country:US
Practice Address - Phone:815-893-6777
Practice Address - Fax:815-893-6764
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3577237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist