Provider Demographics
NPI:1679608822
Name:KLODD, DAVID ANTHONY (PHD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANTHONY
Last Name:KLODD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 43
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-0043
Mailing Address - Country:US
Mailing Address - Phone:847-674-8761
Mailing Address - Fax:847-674-8764
Practice Address - Street 1:800 AUSTIN AVENUE
Practice Address - Street 2:STE 256 EAST
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3454
Practice Address - Country:US
Practice Address - Phone:847-674-8761
Practice Address - Fax:847-674-8764
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000269231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL635770Medicare PIN