Provider Demographics
NPI:1720234511
Name:LINE, RHONDA L (MACCC-SLP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:LINE
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6685 E 117TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-7808
Mailing Address - Country:US
Mailing Address - Phone:219-663-6392
Mailing Address - Fax:219-663-3529
Practice Address - Street 1:6685 E 117TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7808
Practice Address - Country:US
Practice Address - Phone:219-663-6392
Practice Address - Fax:219-663-3529
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004282A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist