Healthcare Provider Details

I. General information

NPI: 1609012236
Provider Name (Legal Business Name): HEIDI M HEDRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2009
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NORTH RITTER AVENUE
INDIANAPOLIS IN
46219-3027
US

IV. Provider business mailing address

8180 CLEARVISTA PARKWAY SUITE 230 ATTN SHERRY MUELLER
INDIANAPOLIS IN
46256-4649
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-2560
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: