Basic Information
| Provider Information | |||||||||
| NPI: | 1558696179 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | REHAL | ||||||||
| FirstName: | BALJIT | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | AU.D, CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 702 BARNHILL DR | ||||||||
| Address2: | RM 0860 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462025128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172746600 | ||||||||
| FaxNumber: | 3172746680 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2009 | ||||||||
| LastUpdateDate: | 03/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 23002407 | IN | N | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | 23002407A | IN | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.