Individual
MADISON STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1441 S FENBROOK LN # 400D, BLOOMINGTON, IN 47401-4176
(812) 322-4494
Mailing address
1383 E SOUTHVIEW LN, PAOLI, IN 47454-9477
(812) 865-0729
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
46004555A
IN
Other
Enumeration date
01/28/2025
Last updated
01/28/2025
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