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NPI Code Detail

MEDICARE: MADISON N HAGERTY SLP

MEDICARE: MADISON N HAGERTY SLP
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
1235Z00000XSpeech-Language Pathologist46004388AIN
2235Z00000XSpeech-Language Pathologist22007427AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11103779393OTHERINANTHEM PTAN

General Provider Information

NPI Number : 1679354682
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADISON N HAGERTY SLP
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 705 RILEY HOSPITAL DR STE 2210
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5109
Country : US
Telephone Number : 317-944-8868
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2023
Last Update Date : 09/26/2024

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Directions to “ MADISON N HAGERTY SLP” Practice Location

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