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NPI Code Detail

MEDICARE: JEAN THORESON SLT-A

MEDICARE: JEAN THORESON SLT-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
12355S0801XSpeech-Language Assistant29001691AIN

General Provider Information

NPI Number : 1760997605
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEAN THORESON SLT-A
Provider Business Mailing Address
First Line : 6060 N COLLEGE AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46220-1907
Country : US
Telephone Number : 260-245-1455
Fax Number : 317-815-3861
Provider Business Practice Location Address
First Line : 3948 NEW VISION DR STE D
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1721
Country : US
Telephone Number : 260-245-1455
Fax Number : 317-815-3861
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2017
Last Update Date : 03/17/2018

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Directions to “ JEAN THORESON SLT-A” Practice Location

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