Organization
HEARTLAND CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SUSANNAH LEIGH DEVAULT MSW, LSW (THERAPIST)
(765) 446-9898
Entity
Organization
Contact information
Practice address
2201 FERRY ST, LAFAYETTE, IN 47904-3047
(765) 446-9898
Mailing address
2201 FERRY ST, LAFAYETTE, IN 47904-3047
(765) 446-9898
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
33005046A
IN
Other
Enumeration date
12/22/2006
Last updated
08/22/2020
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