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NPI Code Detail

MEDICARE: HALEIGH CLARK

MEDICARE: HALEIGH CLARK
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
1106S00000XBehavior TechnicianRBT-24-374075IN

General Provider Information

NPI Number : 1841001641
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEIGH CLARK
Provider Business Mailing Address
First Line : 1061 E SOUTHERN AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-5214
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1061 E SOUTHERN AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46203-5214
Country : US
Telephone Number : 463-701-0909
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/20/2025
Last Update Date : 01/20/2025

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Directions to “ HALEIGH CLARK ” Practice Location

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