Provider Demographics
NPI:1538359997
Name:MIKA, ANN MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:MIKA
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 1:1120 S. CALUMET, #3
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304
Mailing Address - Country:US
Mailing Address - Phone:219-983-9675
Mailing Address - Fax:219-983-9681
Practice Address - Street 1:1120 S. CALUMET, #3
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304
Practice Address - Country:US
Practice Address - Phone:219-983-9675
Practice Address - Fax:219-983-9681
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003689A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist