# BALL STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Interprofessional Community Clinics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093937476
- **Authorized official:** BLAIR SCOTT MATTERN (DIR OF CLINICAL OPERATIONS)
- **Authorized official phone:** (765) 285-5354

## Contact information

- **Practice address:** 1613 W RIVERSIDE AVE HB 155, MUNCIE, IN 47306-1022
- **Practice address phone:** (765) 285-5354
- **Practice address fax:** (765) 285-5623
- **Mailing address:** 1613 W RIVERSIDE AVE HB 155, MUNCIE, IN 47306-1022
- **Mailing address phone:** (765) 285-5354
- **Mailing address fax:** (765) 285-5623

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | 23000144 | IN | — |
| 231H00000X | Audiologist | 23002219A | IN | Yes |
| 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