Individual
JACQUELINE H WYLAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AUD
Contact information
Practice address
705 RILEY HOSPITAL DR, 0860, INDIANAPOLIS, IN 46202-5109
(317) 278-1255
(317) 278-3743
Mailing address
250 N SHADELAND AVE STE 200, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
23001958A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000835776
ANTHEM PROVIDER NUMBER
IN
05
—
200646700
—
IN
Enumeration date
04/11/2013
Last updated
07/31/2020
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