Provider Demographics
NPI:1891544201
Name:VANHOOGSTRAAT, JEANNETTE BEATRIZ
Entity type:Individual
Prefix:
First Name:JEANNETTE
Middle Name:BEATRIZ
Last Name:VANHOOGSTRAAT
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 1:11493 HARLEQUIN LN APT 204
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2469
Mailing Address - Country:US
Mailing Address - Phone:909-685-6052
Mailing Address - Fax:
Practice Address - Street 1:6330 E 75TH ST STE 206
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2700
Practice Address - Country:US
Practice Address - Phone:317-284-1166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46004458A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist