Individual
LISA MICHELLE PENK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
8549 MADISON AVE, INDIANAPOLIS, IN 46227-6153
(317) 881-9164
(317) 887-4060
Mailing address
4714 W STONEHAVEN LN, NEW PALESTINE, IN 46163-9087
(317) 910-0327
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
22004846A
IN
Other
Enumeration date
09/24/2009
Last updated
09/24/2009
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