Healthcare Provider Details

I. General information

NPI: 1588082903
Provider Name (Legal Business Name): JOAN SALTZ STUDENT HID
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3310 E 10TH ST STE 5
JEFFERSONVILLE IN
47130-7285
US

IV. Provider business mailing address

3310 E 10TH ST STE 5
JEFFERSONVILLE IN
47130-7285
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-8280
  • Fax: 812-288-8286
Mailing address:
  • Phone: 812-288-8280
  • Fax: 812-288-8286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number40002603A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: