Healthcare Provider Details

I. General information

NPI: 1558972182
Provider Name (Legal Business Name): LAURA HAYWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA BLODGETT

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8440 ALLISON POINTE BLVD STE 120
INDIANAPOLIS IN
46250-5661
US

IV. Provider business mailing address

8440 ALLISON POINTE BLVD STE 120
INDIANAPOLIS IN
46250-5661
US

V. Phone/Fax

Practice location:
  • Phone: 317-249-2242
  • Fax: 317-663-1175
Mailing address:
  • Phone: 317-249-2242
  • Fax: 317-663-1175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: