Provider Demographics
NPI:1386279768
Name:KINDOLL, HEATHER R (HAD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:R
Last Name:KINDOLL
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:R
Other - Last Name:OSTERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2580 MICHIGAN RD STE A
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2492
Mailing Address - Country:US
Mailing Address - Phone:812-273-6442
Mailing Address - Fax:
Practice Address - Street 1:2580 MICHIGAN RD STE A
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2492
Practice Address - Country:US
Practice Address - Phone:812-273-6442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001527A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist