Healthcare Provider Details

I. General information

NPI: 1518449362
Provider Name (Legal Business Name): KIRSTIE JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2018
Last Update Date: 08/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W GREEN MEADOWS DR
GREENFIELD IN
46140-1014
US

IV. Provider business mailing address

8930 WINDWOOD CIR
INDIANAPOLIS IN
46256-4339
US

V. Phone/Fax

Practice location:
  • Phone: 317-462-3311
  • Fax:
Mailing address:
  • Phone: 574-286-0364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22006815A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: