Provider Demographics
NPI:1639800436
Name:HARGIS, DEVANNE (MT-BC)
Entity Type:Individual
Prefix:
First Name:DEVANNE
Middle Name:
Last Name:HARGIS
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7502 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5510
Mailing Address - Country:US
Mailing Address - Phone:317-442-8655
Mailing Address - Fax:
Practice Address - Street 1:7502 MADISON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5510
Practice Address - Country:US
Practice Address - Phone:317-829-6654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist