Provider Demographics
NPI:1730347626
Name:SEAL, GALE LYNN (MA, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:GALE
Middle Name:LYNN
Last Name:SEAL
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14689 E 256TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:IN
Mailing Address - Zip Code:46030-9401
Mailing Address - Country:US
Mailing Address - Phone:317-691-2619
Mailing Address - Fax:
Practice Address - Street 1:14689 E 256TH ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:IN
Practice Address - Zip Code:46030-9401
Practice Address - Country:US
Practice Address - Phone:317-691-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001808235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100127020AMedicaid
IN200030300AOtherMEDICAID WAIVER