Provider Demographics
NPI:1467668939
Name:BLUE RIVER VALLEY SCHOOLS
Entity Type:Organization
Organization Name:BLUE RIVER VALLEY SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL PROGRAMS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:JO
Authorized Official - Last Name:VICKERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-836-4816
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:MOUNT SUMMIT
Mailing Address - State:IN
Mailing Address - Zip Code:47361-0217
Mailing Address - Country:US
Mailing Address - Phone:765-836-4816
Mailing Address - Fax:
Practice Address - Street 1:303 SOUTH WALNUT
Practice Address - Street 2:
Practice Address - City:MOUNT SUMMIT
Practice Address - State:IN
Practice Address - Zip Code:47361-0217
Practice Address - Country:US
Practice Address - Phone:765-836-4816
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty