Provider Demographics
NPI:1740739689
Name:BOX, JOSEPH ALLEN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:ALLEN
Last Name:BOX
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:MR
Other - First Name:JOEY
Other - Middle Name:ALLEN
Other - Last Name:BOX
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:7380 OAKLAND HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8791
Mailing Address - Country:US
Mailing Address - Phone:317-945-2736
Mailing Address - Fax:
Practice Address - Street 1:118 MEDICAL DR
Practice Address - Street 2:LIFESPAN THERAPY
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2923
Practice Address - Country:US
Practice Address - Phone:317-573-1037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006180A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist