Provider Demographics
NPI:1508362906
Name:HUGHES, ANN STORY (MS ED, TBVI)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:STORY
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MS ED, TBVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3633 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IN
Mailing Address - Zip Code:46034-9699
Mailing Address - Country:US
Mailing Address - Phone:317-513-4115
Mailing Address - Fax:502-489-2966
Practice Address - Street 1:3633 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IN
Practice Address - Zip Code:46034-9699
Practice Address - Country:US
Practice Address - Phone:317-513-4115
Practice Address - Fax:502-489-2966
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN462256222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN8941-42-2961OtherINDIANA OPERATORS LICENSE