Healthcare Provider Details

I. General information

NPI: 1154171874
Provider Name (Legal Business Name): ASHLYN CISZAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10645 RIVERWOOD BLVD
INDIANAPOLIS IN
46234-7703
US

IV. Provider business mailing address

10645 RIVERWOOD BLVD
INDIANAPOLIS IN
46234-7703
US

V. Phone/Fax

Practice location:
  • Phone: 219-477-9094
  • Fax:
Mailing address:
  • Phone: 219-477-9094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34010421A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: