Provider Demographics
NPI:1679596886
Name:GALLIEN, MONICA L (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:L
Last Name:GALLIEN
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:L
Other - Last Name:BURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7486 E CREEK WAY RD
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-5400
Mailing Address - Country:US
Mailing Address - Phone:765-730-3881
Mailing Address - Fax:
Practice Address - Street 1:5391 SHELBY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227
Practice Address - Country:US
Practice Address - Phone:765-730-3881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23002374231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200688330Medicaid