Healthcare Provider Details

I. General information

NPI: 1912143769
Provider Name (Legal Business Name): REBECCA CONNELL PIEPENBRINK M.A., CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 12/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12188A N MERIDIAN ST SUITE 375
CARMEL IN
46032-4406
US

IV. Provider business mailing address

12188A N MERIDIAN ST SUITE 375
CARMEL IN
46032-4406
US

V. Phone/Fax

Practice location:
  • Phone: 317-926-1056
  • Fax: 317-579-0476
Mailing address:
  • Phone: 317-926-1056
  • Fax: 317-579-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002086A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: