Provider Demographics
NPI:1083593701
Name:PATTERSON, IVORYANNA J (MSE)
Entity type:Individual
Prefix:
First Name:IVORYANNA
Middle Name:J
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3032 DUNSTER ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6162
Mailing Address - Country:US
Mailing Address - Phone:317-459-3832
Mailing Address - Fax:
Practice Address - Street 1:3032 DUNSTER ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-6162
Practice Address - Country:US
Practice Address - Phone:317-459-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist