Provider Demographics
NPI:1235586660
Name:LIGHT, RANDI BETH (MS)
Entity Type:Individual
Prefix:MS
First Name:RANDI
Middle Name:BETH
Last Name:LIGHT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SHORE DR
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-1008
Mailing Address - Country:US
Mailing Address - Phone:219-929-8726
Mailing Address - Fax:219-728-1860
Practice Address - Street 1:2005 VALPARAISO ST
Practice Address - Street 2:SUITE 209
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3329
Practice Address - Country:US
Practice Address - Phone:219-252-5464
Practice Address - Fax:219-728-1860
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist