Healthcare Provider Details

I. General information

NPI: 1083950133
Provider Name (Legal Business Name): STEPHANIE PENDLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 FOUNTAIN DR STE D
CROWN POINT IN
46307-5324
US

IV. Provider business mailing address

5201 FOUNTAIN DR STE D
CROWN POINT IN
46307-5324
US

V. Phone/Fax

Practice location:
  • Phone: 219-689-0008
  • Fax:
Mailing address:
  • Phone: 219-689-0008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: