Individual
LA-KESHA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5650 CONGRESSIONAL PL, INDIANAPOLIS, IN 46235-9710
(317) 756-8907
Mailing address
5650 CONGRESSIONAL PL, INDIANAPOLIS, IN 46235-9710
(317) 756-8907
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
247200000X
Other Technician
—
—
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
372600000X
Adult Companion
—
—
374700000X
Technician
—
—
Other
Enumeration date
05/18/2016
Last updated
05/23/2025
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