Healthcare Provider Details

I. General information

NPI: 1861606865
Provider Name (Legal Business Name): CLINTON COUNTY WIC PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CLINTON COUNTY WIC PROGRAM 2120 WASHINGTON AVENUE
FRANKFORT IN
46041
US

IV. Provider business mailing address

8003 CASTLEWAY DRIVE
INDIANAPOLIS IN
46250
US

V. Phone/Fax

Practice location:
  • Phone: 765-659-2131
  • Fax:
Mailing address:
  • Phone: 317-576-1335
  • Fax: 317-576-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: LYNN H. CLOTHIER
Title or Position: CEO
Credential:
Phone: 317-576-1335