Provider Demographics
NPI:1083487250
Name:PHELPS, ALISHA NICOLE (HAD)
Entity Type:Individual
Prefix:
First Name:ALISHA
Middle Name:NICOLE
Last Name:PHELPS
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 W EADS PKWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-1171
Mailing Address - Country:US
Mailing Address - Phone:812-577-0322
Mailing Address - Fax:812-577-0323
Practice Address - Street 1:696 W EADS PKWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-1171
Practice Address - Country:US
Practice Address - Phone:812-577-0322
Practice Address - Fax:812-577-0323
Is Sole Proprietor?:No
Enumeration Date:2023-10-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001614A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist