Provider Demographics
NPI:1689796542
Name:NEIDIGH, MARY (M A)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NEIDIGH
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9111 HAVERSTICK RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-1353
Mailing Address - Country:US
Mailing Address - Phone:317-575-6500
Mailing Address - Fax:317-575-6501
Practice Address - Street 1:9111 HAVERSTICK RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-1353
Practice Address - Country:US
Practice Address - Phone:317-575-6500
Practice Address - Fax:317-575-6501
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001534A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health