Provider Demographics
NPI:1598993347
Name:WARKENTIEN, JUDITH GAIL (MS EDU/SPEECH ENDORS)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:GAIL
Last Name:WARKENTIEN
Suffix:
Gender:F
Credentials:MS EDU/SPEECH ENDORS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:1060 E 86TH ST STE 65C
Mailing Address - Street 2:P.O BOX 40696
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1831
Mailing Address - Country:US
Mailing Address - Phone:317-443-7667
Mailing Address - Fax:317-994-2010
Practice Address - Street 1:1060 E 86TH ST
Practice Address - Street 2:SUITE 65C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1863
Practice Address - Country:US
Practice Address - Phone:317-443-7667
Practice Address - Fax:317-994-2010
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004408A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist