| Revisit Play, Llc | |
|
1140 S Morton St Bloomington IN 47403-4744 | |
| (812) 727-4922 | |
| Not Available |
| Full Name | Revisit Play, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 1140 S Morton St, Bloomington, Indiana |
| Authorized Official Name and Position | Whitney Sullivan (RENDERING PROVIDER) |
| Authorized Official Contact | 8127274922 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Revisit Play, Llc Po Box 1424 Bloomington IN 47402-1424 Ph: (812) 727-4922 | Revisit Play, Llc 1140 S Morton St Bloomington IN 47403-4744 Ph: (812) 727-4922 |
| NPI Number | 1740152644 |
|---|---|
| Provider Enumeration Date | 09/19/2025 |
| Last Update Date | 09/19/2025 |
| Certification Date | 09/19/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740152644 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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