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General NPI Number Information
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NPI Number | 1538318183
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Entity Type | Individual
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Provider Name | LESA N BLACKHURST M.S., CCC, SLP
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Gender | Female
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 12/02/2013
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Provider Practice Location Address
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Address Line | 11725 N ILLINOIS ST STE 445
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City | CARMEL
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State | IN
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Zip | 46032-3010
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Country | US
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Telephone | 317-844-7059
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Fax | 317-573-4352
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Provider Business Mailing Address
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Address Line | 9002 N MERIDIAN ST STE 222
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-5350
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Country | US
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Telephone | 317-573-4370
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Fax | 317-819-0044
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 22003848A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22003848A
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License Number State | IN
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