Healthcare Provider Details

I. General information

NPI: 1740473107
Provider Name (Legal Business Name): KATHERINE SUZANNE HIGINBOTHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12315 HANCOCK ST STE 27
CARMEL IN
46032-5885
US

IV. Provider business mailing address

12315 HANCOCK ST STE 27
CARMEL IN
46032-5885
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-1113
  • Fax: 317-975-0650
Mailing address:
  • Phone: 317-688-1113
  • Fax: 317-975-0650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002379A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: