Healthcare Provider Details

I. General information

NPI: 1588476154
Provider Name (Legal Business Name): BAILEIGH HOFER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1022 E 52ND ST
INDIANAPOLIS IN
46205-1205
US

IV. Provider business mailing address

1323 LEMANS CT APT 607
INDIANAPOLIS IN
46205-1263
US

V. Phone/Fax

Practice location:
  • Phone: 317-584-5166
  • Fax:
Mailing address:
  • Phone: 317-412-3925
  • 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: