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General NPI Number Information
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NPI Number | 1811149842
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Entity Type | Individual
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Provider Name | TISHA NICOLE VANCUREN CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 1060 E 86TH ST SUITE 65C
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-1863
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Country | US
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Telephone | 317-696-4551
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Fax |
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Provider Business Mailing Address
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Address Line | 10452 DARK STAR DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46234-9853
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Country | US
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Telephone | 317-696-4874
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Fax |
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22004613A
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License Number State | IN
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