Organization
SOUTHLAKE SPEECH & HEARING CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACLIN K. PROCTOR M.A., CCC-A (AUDIOLOGIST)
(219) 738-2528
Entity
Organization
Contact information
Practice address
99 E 86TH AVE, SUITE A, MERRILLVILLE, IN 46410-6381
(219) 738-2528
(219) 756-7825
Mailing address
99 E 86TH AVE, SUITE A, MERRILLVILLE, IN 46410-6381
(219) 738-2528
(219) 756-7825
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
481-20
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100466380A
—
IN
Enumeration date
11/29/2006
Last updated
06/20/2013
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