Provider Demographics
NPI:1386860252
Name:BRADY, JANE (SLP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 WALNUT LN
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-1665
Mailing Address - Country:US
Mailing Address - Phone:219-696-6432
Mailing Address - Fax:219-696-6432
Practice Address - Street 1:534 WALNUT LN
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1665
Practice Address - Country:US
Practice Address - Phone:219-696-6432
Practice Address - Fax:219-696-6432
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003480A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200654350Medicaid