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General NPI Number Information
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NPI Number | 1790660629
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Entity Type | Individual
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Provider Name | HEATHER MARIE CLEMONS
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Gender | Female
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Dates
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Enumeration Date | 08/08/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 2855 MILLER DR STE 109
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City | PLYMOUTH
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State | IN
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Zip | 46563-8091
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Country | US
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Telephone | 317-669-1232
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 S STATE ROAD 23
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City | KNOX
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State | IN
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Zip | 46534-8233
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Country | US
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Telephone | 574-806-2727
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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