Provider Demographics
NPI:1861778961
Name:HITTLE, LYDIA (MA CCC-SLP)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:
Last Name:HITTLE
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 1:1238 OAK LN
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-3214
Mailing Address - Country:US
Mailing Address - Phone:317-512-5364
Mailing Address - Fax:
Practice Address - Street 1:1238 OAK LN
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-3214
Practice Address - Country:US
Practice Address - Phone:317-512-5364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004373A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist