Healthcare Provider Details

I. General information

NPI: 1093290249
Provider Name (Legal Business Name): MENDY ANN MCCLAIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2018
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 PROFESSIONAL CT
LAFAYETTE IN
47905-5152
US

IV. Provider business mailing address

7087 N COUNTY ROAD 900 E
BROWNSBURG IN
46112-9017
US

V. Phone/Fax

Practice location:
  • Phone: 317-374-0192
  • Fax:
Mailing address:
  • Phone: 317-374-0192
  • Fax:

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: