Provider Demographics
NPI:1740909332
Name:HEADLEY, CORY ANN
Entity type:Individual
Prefix:
First Name:CORY
Middle Name:ANN
Last Name:HEADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 WESLEY RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-3653
Mailing Address - Country:US
Mailing Address - Phone:260-925-2453
Mailing Address - Fax:260-925-0830
Practice Address - Street 1:1800 WESLEY RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-3653
Practice Address - Country:US
Practice Address - Phone:260-925-2453
Practice Address - Fax:260-925-0830
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34007886A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical