Provider Demographics
NPI:1225398613
Name:VERSON, JAMES BRIAN (HIS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:BRIAN
Last Name:VERSON
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 1:595 SOUTHEAST ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:IL
Mailing Address - Zip Code:62001-2547
Mailing Address - Country:US
Mailing Address - Phone:618-793-0297
Mailing Address - Fax:
Practice Address - Street 1:411 N STATE ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-2038
Practice Address - Country:US
Practice Address - Phone:618-973-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-21
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3043237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist