Healthcare Provider Details

I. General information

NPI: 1730007790
Provider Name (Legal Business Name): ALEXANDRIA GAEL BALLARD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6249 S EAST ST STE E
INDIANAPOLIS IN
46227-2089
US

IV. Provider business mailing address

2831 S YONKERS CT
BLOOMINGTON IN
47403-3809
US

V. Phone/Fax

Practice location:
  • Phone: 317-561-1888
  • Fax: 317-791-9001
Mailing address:
  • Phone: 317-561-1888
  • Fax: 317-791-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: