Healthcare Provider Details

I. General information

NPI: 1427979111
Provider Name (Legal Business Name): ELIZABETH DIANE BERRONES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH DIANE BERRONES-LAMPE

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5187
US

IV. Provider business mailing address

18733 EXPLANADE ST
WESTFIELD IN
46074-0757
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number22008094A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: