Individual
JACQUELINE NICOLE DITSLEAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
1628 HOYT AVE, INDIANAPOLIS, IN 46203-1205
(317) 869-9784
Mailing address
1628 HOYT AVE, INDIANAPOLIS, IN 46203-1205
(317) 869-9784
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22007531A
IN
235Z00000X
Speech-Language Pathologist
46003526A
IN
Other
Enumeration date
06/03/2019
Last updated
01/12/2022
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