Provider Demographics
NPI:1255916532
Name:HUERTAS, TIYE VICTORIA (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:TIYE
Middle Name:VICTORIA
Last Name:HUERTAS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:175 MARKET PLACE DR STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-4471
Practice Address - Country:US
Practice Address - Phone:502-251-7002
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLSA17355235Z00000X
KY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist