Healthcare Provider Details

I. General information

NPI: 1295137925
Provider Name (Legal Business Name): BALL STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HB 155
MUNCIE IN
47306-0001
US

IV. Provider business mailing address

2000 W UNIVERSITY AVE
MUNCIE IN
47306-1022
US

V. Phone/Fax

Practice location:
  • Phone: 765-285-4422
  • Fax: 765-285-5623
Mailing address:
  • Phone: 765-285-5354
  • Fax: 765-285-5623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BLAIR SCOTT MATTERN
Title or Position: ASSOCIATE DEAN FOR CLINICAL AFFAIRS
Credential:
Phone: 765-285-5354