NPIMap

Organization Active NPI

Southlake Speech & Hearing Center, Inc

  • Audiologist
  • Merrillville, IN
National Provider Identifier
1609943380
Registry record updated Jun 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
481-20 Issued in IN
Legal business name
SOUTHLAKE SPEECH & HEARING CENTER, INC
Practice address
99 E 86TH Ave
Suite a
Merrillville, IN 46410-6381
Phone
(219) 738-2528
Fax
(219) 756-7825
NPI assigned
Nov 29, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jaclin K. Proctor, M.A., CCC-A
Title
Audiologist
Phone
(219) 738-2528

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
AudiologistGroup: 193400000X SINGLE SPECIALTY GROUP 231H00000X 481-20 IN Primary

Addresses

Primary practice location

99 E 86TH Ave
Suite a
Merrillville, IN 46410-6381

Mailing address

99 E 86TH Ave
Suite a
Merrillville, IN 46410-6381
Phone (219) 738-2528

Other identifiers 1

IdentifierTypeStateIssuer
100466380AMedicaidIN

National Provider Directory

National Provider Directory

Locations

99 E 86th Ave
Ste A
Merrillville, IN 46410
Phone (219) 738-2528

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371686400000",
    "number": "1609943380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "99 E 86TH AVE",
            "address_2": "SUITE A",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106381",
            "telephone_number": "219-738-2528",
            "fax_number": "219-756-7825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "99 E 86TH AVE",
            "address_2": "SUITE A",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106381",
            "telephone_number": "219-738-2528",
            "fax_number": "219-756-7825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHLAKE SPEECH & HEARING CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2013-06-20",
        "status": "A",
        "authorized_official_last_name": "PROCTOR",
        "authorized_official_first_name": "JACLIN",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "AUDIOLOGIST",
        "authorized_official_telephone_number": "219-738-2528",
        "authorized_official_credential": "M.A., CCC-A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Audiologist",
            "state": "IN",
            "license": "481-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100466380A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Merrillville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.