Healthcare Provider Details

I. General information

NPI: 1194920645
Provider Name (Legal Business Name): LIBBY YOUNGER BC-HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 W STATE ROAD 45
BLOOMINGTON IN
47403-5107
US

IV. Provider business mailing address

3205 W STATE ROAD 45
BLOOMINGTON IN
47403-5107
US

V. Phone/Fax

Practice location:
  • Phone: 812-558-7391
  • Fax: 812-333-8918
Mailing address:
  • Phone: 812-558-7391
  • Fax: 812-333-8918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17000848A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: