Healthcare Provider Details

I. General information

NPI: 1194927038
Provider Name (Legal Business Name): HEATHER M MICKEY AU.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER M LOBUE

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6920 PARKDALE PL STE 203
INDIANAPOLIS IN
46254-5611
US

IV. Provider business mailing address

6920 PARKDALE PL STE 203
INDIANAPOLIS IN
46254-5611
US

V. Phone/Fax

Practice location:
  • Phone: 888-445-8745
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002326A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: