Healthcare Provider Details

I. General information

NPI: 1164848172
Provider Name (Legal Business Name): TALLI HOERSTEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7424 SHADELAND STATION WAY
INDIANAPOLIS IN
46256-3925
US

IV. Provider business mailing address

4486 WINDSOR RD
BROWNSBURG IN
46112-8564
US

V. Phone/Fax

Practice location:
  • Phone: 317-288-7606
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: