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Organization
MICHIANA THERAPY NETWORK
Active
Organization
MICHIANA THERAPY NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACEY LEE GANGLUFF M.S.,CCC-SLP (SPEECH PATHOLOGIST)
(574) 339-5959
Entity
Organization
Contact information
Practice address
51738 SAGECREST DR, GRANGER, IN 46530-6887
(574) 339-5959
Mailing address
51738 SAGECREST DR, GRANGER, IN 46530-6887
(574) 339-5959
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
05006025A
IN
225X00000X
Occupational Therapist
31000509A
IN
235Z00000X
Speech-Language Pathologist
Primary
01101056
IN
Other
Enumeration date
12/18/2009
Last updated
03/19/2010
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