Healthcare Provider Details

I. General information

NPI: 1194523233
Provider Name (Legal Business Name): CHLOE GUMM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2025
Last Update Date: 03/05/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N. ILLINOIS STREET 16TH FLOOR S TOWER
INDIANAPOLIS IN
46204-4232
US

IV. Provider business mailing address

201 N. ILLINOIS STREET 16TH FLOOR S TOWER
INDIANAPOLIS IN
46204-4232
US

V. Phone/Fax

Practice location:
  • Phone: 463-244-5821
  • Fax:
Mailing address:
  • Phone: 463-244-5821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-330809
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: