MEDICARE: LYDIA HITTLE MA CCC-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
1	235Z00000X	Speech-Language Pathologist	22004373A	IN

General Provider Information

NPI Number	:	1861778961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYDIA HITTLE MA CCC-SLP

Provider Business Mailing Address
First Line	:	1238 OAK LN
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-3214
Country	:	US
Telephone Number	:	317-512-5364
Fax Number	:

Provider Business Practice Location Address
First Line	:	1238 OAK LN
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-3214
Country	:	US
Telephone Number	:	317-512-5364
Fax Number	:

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

Provider Enumeration Date	:	11/02/2011
Last Update Date	:	11/02/2011

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Directions to “ LYDIA HITTLE MA CCC-SLP” Practice Location

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