Healthcare Provider Details

I. General information

NPI: 1538645197
Provider Name (Legal Business Name): STAND LOOK ASK WALK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2018
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10405 FOX RUN CT
FISHERS IN
46037-9257
US

IV. Provider business mailing address

10405 FOX RUN CT
FISHERS IN
46037-9257
US

V. Phone/Fax

Practice location:
  • Phone: 317-529-4387
  • Fax:
Mailing address:
  • Phone: 317-529-4387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANE ELIZABETH GOODER
Title or Position: MEMBER
Credential: M ED RD
Phone: 317-528-4387