Individual
JEFFREY CLEVENGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.S.
Contact information
Practice address
1801 S 18TH ST, LAFAYETTE, IN 47905-2011
(765) 772-4711
Mailing address
2043 E 430 S, LAFAYETTE, IN 47909-8105
(765) 772-4711
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36000065A
IN
Other
Enumeration date
11/28/2015
Last updated
11/28/2015
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