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General NPI Number Information
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NPI Number | 1104470178
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Entity Type | Individual
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Provider Name | DONALD RAMBO CONNOR MACLEAN-KENNEDY
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Gender | Male
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Dates
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Enumeration Date | 07/29/2019
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Last Update Date | 07/29/2019
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Provider Practice Location Address
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Address Line | 3073 SALT LAKE RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46214-1432
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Country | US
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Telephone | 317-296-4187
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Fax |
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Provider Business Mailing Address
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Address Line | 10171 TOUCHSTONE DR
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City | FISHERS
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State | IN
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Zip | 46038-8747
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Country | US
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Telephone | 317-525-4483
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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