Healthcare Provider Details

I. General information

NPI: 1669202446
Provider Name (Legal Business Name): REBECCA DAUGHERTY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 08/06/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

INCLUSIVE OPTIONS LLC 4070 25TH STREET
COLUMBUS IN
47203
US

IV. Provider business mailing address

2758 VIOLET WAY
COLUMBUS IN
47201-8841
US

V. Phone/Fax

Practice location:
  • Phone: 812-373-6103
  • Fax:
Mailing address:
  • Phone: 812-371-4477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: