Provider Demographics
NPI:1366123325
Name:PRATER, ADRIENNE A
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:A
Last Name:PRATER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 MCCULLOCH BLVD N STE A-102
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-6976
Mailing Address - Country:US
Mailing Address - Phone:928-453-0303
Mailing Address - Fax:928-453-0338
Practice Address - Street 1:1760 MCCULLOCH BLVD N STE A-102
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6976
Practice Address - Country:US
Practice Address - Phone:928-453-0303
Practice Address - Fax:928-453-0338
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHADE12728237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist