Healthcare Provider Details

I. General information

NPI: 1043973308
Provider Name (Legal Business Name): HANNAH MIEURE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/14/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 PROFESSIONAL CT
LAFAYETTE IN
47905-5209
US

IV. Provider business mailing address

20 PROFESSIONAL CT
LAFAYETTE IN
47905-5209
US

V. Phone/Fax

Practice location:
  • Phone: 765-423-7988
  • Fax:
Mailing address:
  • Phone: 765-423-7988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number29001946A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: