Individual
STACEY L BOLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-A
Contact information
Practice address
18000 RIVER AVE, NOBLESVILLE, IN 46062-8329
(317) 773-6579
(317) 776-4557
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23002258A
IN
237600000X
Audiologist-Hearing Aid Fitter
23002258A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01027070
MEDICARE RR PTAN
IN
Enumeration date
03/30/2008
Last updated
02/28/2018
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