Healthcare Provider Details

I. General information

NPI: 1720975550
Provider Name (Legal Business Name): MONICA MICHELLE WEARREN RYT-200, MHA,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 ALLISONVILLE RD
INDIANAPOLIS IN
46205-2415
US

IV. Provider business mailing address

4905 FLAME WAY
INDIANAPOLIS IN
46254-5958
US

V. Phone/Fax

Practice location:
  • Phone: 317-213-5937
  • Fax:
Mailing address:
  • Phone: 317-213-5937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225CX0006X
TaxonomyOrientation and Mobility Training Rehabilitation Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: