Provider Demographics
NPI:1548602170
Name:MCCLOSKEY, TRAVIS
Entity Type:Individual
Prefix:MR
First Name:TRAVIS
Middle Name:
Last Name:MCCLOSKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12315 HANCOCK ST STE 27
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5885
Mailing Address - Country:US
Mailing Address - Phone:317-688-1113
Mailing Address - Fax:317-975-0650
Practice Address - Street 1:12315 HANCOCK ST STE 27
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2930
Practice Address - Country:US
Practice Address - Phone:317-727-1625
Practice Address - Fax:317-975-0650
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001402A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1OtherHIS HEARING INSTRUMENT SPECIALIST