Provider Demographics
NPI:1962868679
Name:HERSHBERGER, KAYLEE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:HERSHBERGER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1776 N MERIDIAN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1469
Mailing Address - Country:US
Mailing Address - Phone:317-257-2229
Mailing Address - Fax:
Practice Address - Street 1:1776 N MERIDIAN ST STE 300
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1469
Practice Address - Country:US
Practice Address - Phone:317-257-2229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5607235Z00000X
IN22007244A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist