# SOUTHLAKE SPEECH & HEARING CENTER, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1609943380
- **Authorized official:** JACLIN K. PROCTOR M.A., CCC-A (AUDIOLOGIST)
- **Authorized official phone:** (219) 738-2528

## Contact information

- **Practice address:** 99 E 86TH AVE, SUITE A, MERRILLVILLE, IN 46410-6381
- **Practice address phone:** (219) 738-2528
- **Practice address fax:** (219) 756-7825
- **Mailing address:** 99 E 86TH AVE, SUITE A, MERRILLVILLE, IN 46410-6381
- **Mailing address phone:** (219) 738-2528
- **Mailing address fax:** (219) 756-7825

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | 481-20 | IN | Yes |

## Other

- **Enumeration date:** 11/29/2006
- **Last updated:** 06/20/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100466380A | — | IN |