Individual
HEATHER BOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3630 WILLOWCREEK RD, PORTAGE, IN 46368-5075
(219) 364-3000
Mailing address
9460 W OAKRIDGE DR, SAINT JOHN, IN 46373-9212
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
46002738A
IN
Other
Enumeration date
09/29/2015
Last updated
09/29/2015
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