Provider Demographics
NPI:1144667825
Name:PRAIRIE, DYANNA JM HAMSTRA (AUD)
Entity type:Individual
Prefix:DR
First Name:DYANNA
Middle Name:JM HAMSTRA
Last Name:PRAIRIE
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:DYANNA
Other - Middle Name:J
Other - Last Name:HAMSTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:2601 BEECH ST
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-6008
Mailing Address - Country:US
Mailing Address - Phone:219-464-9580
Mailing Address - Fax:219-464-0640
Practice Address - Street 1:901 MACARTHUR BLVD
Practice Address - Street 2:AUDIOLOGY DEPARTMENT
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-836-1600
Practice Address - Fax:219-703-6776
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002532A237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter