Provider Demographics
NPI:1083836845
Name:LINGLE, TERRY L (HAD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:LINGLE
Suffix:
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 VIGO ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-2832
Mailing Address - Country:US
Mailing Address - Phone:812-882-5040
Mailing Address - Fax:812-882-5040
Practice Address - Street 1:704 VIGO ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-2832
Practice Address - Country:US
Practice Address - Phone:812-882-5040
Practice Address - Fax:812-882-5040
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001283A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200849100 AMedicaid