Healthcare Provider Details

I. General information

NPI: 1245151844
Provider Name (Legal Business Name): MS. KORTNI LIGGONS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5915 S EMERSON AVE
INDIANAPOLIS IN
46237-1971
US

IV. Provider business mailing address

175 E ROBERTS RD
INDIANAPOLIS IN
46227-1661
US

V. Phone/Fax

Practice location:
  • Phone: 317-567-9307
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: