Provider Demographics
NPI:1447472998
Name:STORNETTA, CARLA TRUESDALE (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:TRUESDALE
Last Name:STORNETTA
Suffix:
Gender:F
Credentials:MS 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:P.O. BOX 40696
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-0696
Mailing Address - Country:US
Mailing Address - Phone:317-370-1053
Mailing Address - Fax:317-566-8260
Practice Address - Street 1:1060 E. 86TH STREET
Practice Address - Street 2:SUITE 65C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1863
Practice Address - Country:US
Practice Address - Phone:317-370-1053
Practice Address - Fax:317-566-8260
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003976A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist