Provider Demographics
NPI:1043505233
Name:MCILVAINE, TERRY L (AUD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:MCILVAINE
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 1:365 RIFFEL RD STE D
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-8592
Mailing Address - Country:US
Mailing Address - Phone:330-439-4106
Mailing Address - Fax:330-345-3003
Practice Address - Street 1:365 RIFFEL RD STE D
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-8592
Practice Address - Country:US
Practice Address - Phone:330-439-4106
Practice Address - Fax:330-345-3003
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000172231H00000X
OHA.02554231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist