Provider Demographics
NPI:1811157779
Name:FORTMAN, DEBBIE
Entity type:Individual
Prefix:MS
First Name:DEBBIE
Middle Name:
Last Name:FORTMAN
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:PO BOX 1369
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-6269
Mailing Address - Country:US
Mailing Address - Phone:317-782-4346
Mailing Address - Fax:317-782-4347
Practice Address - Street 1:6512 GREYRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3162
Practice Address - Country:US
Practice Address - Phone:317-782-4346
Practice Address - Fax:317-782-4347
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100121240AMedicaid