=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598993347
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH GAIL WARKENTIEN MS EDU/SPEECH ENDORS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/30/2009
-----------------------------------------------------
Last Update Date | 06/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1060 E 86TH ST SUITE 65C
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46240-1863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-443-7667
-----------------------------------------------------
Fax | 317-994-2010
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1060 E 86TH ST STE 65C P.O BOX 40696
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46240-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-443-7667
-----------------------------------------------------
Fax | 317-994-2010
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 22004408A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------