Provider Demographics
NPI:1508594847
Name:BIRGE, ANTOINETTE ALLERELLI
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:ALLERELLI
Last Name:BIRGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 CLEARWATER LN APT 208
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1580
Mailing Address - Country:US
Mailing Address - Phone:812-631-0138
Mailing Address - Fax:
Practice Address - Street 1:7001 HOOVER RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-4169
Practice Address - Country:US
Practice Address - Phone:317-251-2261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-14
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist