Basic Information
| Provider Information | |||||||||
| NPI: | 1407935240 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOCKER | ||||||||
| FirstName: | ADAM | ||||||||
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| Credential: | MCD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1189 CANYON WAY | ||||||||
| Address2: | |||||||||
| City: | WELLINGTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617955433 | ||||||||
| FaxNumber: | 5617926779 | ||||||||
| Practice Location | |||||||||
| Address1: | 7301A WEST PALMETTO PK RD | ||||||||
| Address2: | SUITE 202 C | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613936161 | ||||||||
| FaxNumber: | 5613935331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AY981 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.