Healthcare Provider Details

I. General information

NPI: 1215558754
Provider Name (Legal Business Name): MRS. COURTNEY NICOLE MCFADDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS COURTNEY NICOLE GEORGE

II. Dates (important events)

Enumeration Date: 05/06/2020
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10503 E STATE ROAD 54
BLOOMFIELD IN
47424-6066
US

IV. Provider business mailing address

252 THE WOODS
BEDFORD IN
47421-9377
US

V. Phone/Fax

Practice location:
  • Phone: 812-825-5623
  • Fax:
Mailing address:
  • Phone: 812-521-2849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: