Healthcare Provider Details

I. General information

NPI: 1215802210
Provider Name (Legal Business Name): ALLEIGH COOPER CLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1521 ASHLEY DR
LEBANON IN
46052-1008
US

IV. Provider business mailing address

1521 ASHLEY DR
LEBANON IN
46052-1008
US

V. Phone/Fax

Practice location:
  • Phone: 317-372-4829
  • Fax:
Mailing address:
  • Phone: 317-372-4829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number367796
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: