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Organization
BALL STATE UNIVERSITY
Active
Organization
BALL STATE UNIVERSITY
Active
Other names
Interprofessional Community Clinics
Organization subpart
No
Provider details
NPI number
Authorized official
BLAIR SCOTT MATTERN (DIR OF CLINICAL OPERATIONS)
(765) 285-5354
Entity
Organization
Contact information
Practice address
1613 W RIVERSIDE AVE HB 155, MUNCIE, IN 47306-1022
(765) 285-5354
(765) 285-5623
Mailing address
1613 W RIVERSIDE AVE HB 155, MUNCIE, IN 47306-1022
(765) 285-5354
(765) 285-5623
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
23000144
IN
231H00000X
Audiologist
Primary
23002219A
IN
231H00000X
Audiologist
23002244A
IN
231H00000X
Audiologist
23002284A
IN
235Z00000X
Speech-Language Pathologist
22000224A
IN
235Z00000X
Speech-Language Pathologist
22001549
IN
235Z00000X
Speech-Language Pathologist
22001560
IN
235Z00000X
Speech-Language Pathologist
22001890A
IN
235Z00000X
Speech-Language Pathologist
22001905A
IN
235Z00000X
Speech-Language Pathologist
22002004A
IN
235Z00000X
Speech-Language Pathologist
22002106
IN
235Z00000X
Speech-Language Pathologist
22002254A
IN
235Z00000X
Speech-Language Pathologist
22002571
IN
235Z00000X
Speech-Language Pathologist
22003456A
IN
235Z00000X
Speech-Language Pathologist
22003906A
IN
Other
Enumeration date
05/03/2007
Last updated
12/20/2021
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