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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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