MEDICARE: MRS. LISA REINHOLT BUSALD M.S., CCC-A

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	231H00000X	Audiologist	23001885	IN

General Provider Information

NPI Number	:	1760652226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA REINHOLT BUSALD M.S., CCC-A

Provider Business Mailing Address
First Line	:	7440 N SHADELAND AVE
Second Line	:	STE. 150
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2029
Country	:	US
Telephone Number	:	317-842-4901
Fax Number	:

Provider Business Practice Location Address
First Line	:	7440 N SHADELAND AVE
Second Line	:	STE. 150
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2029
Country	:	US
Telephone Number	:	317-842-4901
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	03/11/2008

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