Provider Demographics
NPI:1447291794
Name:LEWALLEN, BARBARA A (AUD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:LEWALLEN
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 1:172 SCHILLER
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126
Mailing Address - Country:US
Mailing Address - Phone:630-758-8530
Mailing Address - Fax:763-268-4240
Practice Address - Street 1:1200 S. YORK RD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126
Practice Address - Country:US
Practice Address - Phone:630-941-2603
Practice Address - Fax:630-758-8494
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147000216237600000X
IL147,00216231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL82793Medicare ID - Type UnspecifiedIND PROV ID NUMBER