MEDICARE: TRUSTEES OF PURDUE UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1619055712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRUSTEES OF PURDUE UNIVERSITY

Provider Business Mailing Address
First Line	:	601 STADIUM MALL DRIVE
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47907-2052
Country	:	US
Telephone Number	:	765-496-1927
Fax Number	:	765-496-1227

Provider Business Practice Location Address
First Line	:	715 CLINIC DR
Second Line	:	ROOM 1042
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47907-2122
Country	:	US
Telephone Number	:	765-494-3789
Fax Number	:	765-494-0771

Authorized Official
Title or Position	:	DEPUTY GENERAL COUNSEL
Name	:	TRENTEN D KLINGERMAN
Credential	:
Telephone Number	:	765-496-6846

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	08/03/2020

Similar Medicare Providers

1497832083 — DR. LYSA CHARLES MD
Practice Location Address:

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308

1588838932 — CHRISTI M MASTERS MS CCC SLP
Practice Location Address:

715 CLINIC DR
WEST LAFAYETTE, IN
47907-2122

Practice Phone: 765-496-7962
Practice Fax:

1265794465 — MRS. ANNE MARIE GRITT M.S., CCC-SLP
Practice Location Address:

715 CLINIC DR
WEST LAFAYETTE, IN
47907-2122

Practice Phone: 765-496-3192
Practice Fax:

1992147631 — DR. ZACHARY SCOTT LA FRATTA AU.D.
Practice Location Address:

715 CLINIC DR
WEST LAFAYETTE, IN
47907-2122

Practice Phone: 765-494-4229
Practice Fax:

1154705010 — LAURA NETTESHEIM CCC-SLP
Practice Location Address:

715 CLINIC DR
WEST LAFAYETTE, IN
47907-2122

Practice Phone: 765-494-3789
Practice Fax:

1235680224 — CHARLOTTE JOY ALEXANDRA STEELE-MORRIS M.D.
Practice Location Address:

715 CLINIC DR , PURDUE UNIVERSITY, LYLES-PORTER HALL
WEST LAFAYETTE, IN
47907-2122

Practice Phone: 765-494-8588
Practice Fax:

Directions to “TRUSTEES OF PURDUE UNIVERSITY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.