Healthcare Provider Details

I. General information

NPI: 1467382168
Provider Name (Legal Business Name): KERRI MATHEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2785 CASON ST
LAFAYETTE IN
47904-2843
US

IV. Provider business mailing address

55749 BLACK PHEASANT DR
OSCEOLA IN
46561-8516
US

V. Phone/Fax

Practice location:
  • Phone: 765-571-4984
  • Fax: 855-915-0244
Mailing address:
  • Phone: 574-707-5142
  • 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: