Provider Demographics
NPI:1104091073
Name:HERSEY, CHRISTOPHER (BC-HIS)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:HERSEY
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-5316
Mailing Address - Country:US
Mailing Address - Phone:765-935-7844
Mailing Address - Fax:
Practice Address - Street 1:213 SW 2ND ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-5316
Practice Address - Country:US
Practice Address - Phone:765-935-7844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17000902A235500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235500000XSpeech, Language and Hearing Service ProvidersSpecialist/Technologist