Provider Demographics
NPI:1205913696
Name:KORTEPETER, TATIA L (SLP)
Entity type:Individual
Prefix:
First Name:TATIA
Middle Name:L
Last Name:KORTEPETER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 STRAWFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-6924
Mailing Address - Country:US
Mailing Address - Phone:317-282-2506
Mailing Address - Fax:317-881-3421
Practice Address - Street 1:4340 STRAWFLOWER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-6924
Practice Address - Country:US
Practice Address - Phone:317-282-2506
Practice Address - Fax:317-881-3421
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003106235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
11585324OtherCAQH