Provider Demographics
NPI:1962510156
Name:ENGEL, TERRY ANN (AUD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:ANN
Last Name:ENGEL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18000 RIVER RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8329
Practice Address - Country:US
Practice Address - Phone:317-621-6673
Practice Address - Fax:317-621-3073
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000592231H00000X
IN23001530A231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01751323OtherRR MEDICARE
IN201347440Medicaid
IN047930014Medicare PIN
ININ1332050Medicare PIN
INP01751323OtherRR MEDICARE