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NPI Code Detail

MEDICARE: RENAE CLARK-WEATHERLY

MEDICARE: RENAE CLARK-WEATHERLY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251B00000XCase Management Agency
2251S00000XCommunity/Behavioral Health Agency99074128AIN
3251B00000XCase Management Agency99064493AIN

General Provider Information

NPI Number : 1275043069
Entity Type Code : Organization
Provider Name (Legal Business Name) : RENAE CLARK-WEATHERLY
Provider Business Mailing Address
First Line : 5126 GUION RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-1725
Country : US
Telephone Number : 317-222-9704
Fax Number :
Provider Business Practice Location Address
First Line : 4126 E 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46201-2613
Country : US
Telephone Number : 317-686-0931
Fax Number : 866-406-5077
Authorized Official
Title or Position : THERAPIST
Name : RENAE CLARK-WEATHERLY
Credential : MA
Telephone Number : 317-222-9704
Provider Enumeration Date : 10/05/2017
Last Update Date : 09/01/2024

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Directions to “RENAE CLARK-WEATHERLY ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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