Healthcare Provider Details

I. General information

NPI: 1801622600
Provider Name (Legal Business Name): HALLIE GUST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 CUMBERLAND AVE
WEST LAFAYETTE IN
47906-1310
US

IV. Provider business mailing address

6170 E 400 N
KOKOMO IN
46901-9311
US

V. Phone/Fax

Practice location:
  • Phone: 317-762-2875
  • Fax:
Mailing address:
  • Phone: 317-762-2875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99138674A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: