Healthcare Provider Details

I. General information

NPI: 1144034364
Provider Name (Legal Business Name): HARLEY SHUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W WASHINGTON ST
WAYNETOWN IN
47990-8022
US

IV. Provider business mailing address

PO BOX 162
WAYNETOWN IN
47990-0162
US

V. Phone/Fax

Practice location:
  • Phone: 765-326-1501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: