Provider Demographics
NPI:1770825762
Name:EDDY, COURTNEY (GENETIC COUNSELOR)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:EDDY
Suffix:
Gender:F
Credentials:GENETIC COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7120 CLEARVISTA DR STE 5900
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1714
Practice Address - Country:US
Practice Address - Phone:317-621-9210
Practice Address - Fax:317-621-9211
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300012341Medicaid