Provider Demographics
NPI:1922391762
Name:ST. JOSEPH INSTITUTE FOR THE DEAF INDIANA SERVICE CORPORATION
Entity Type:Organization
Organization Name:ST. JOSEPH INSTITUTE FOR THE DEAF INDIANA SERVICE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-532-3211
Mailing Address - Street 1:1809 CLARKSON RD
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5065
Mailing Address - Country:US
Mailing Address - Phone:636-532-3211
Mailing Address - Fax:636-532-4560
Practice Address - Street 1:9192 WALDEMAR RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1131
Practice Address - Country:US
Practice Address - Phone:317-471-8560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST. JOSEPH INSTITUTE FOR THE DEAF
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-26
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty