Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1083138929 |
---|---|
Provider Name | Ms. Madison Collins |
First Address | Indianapolis, IN 46220-1907 |
Second Address | Fort Wayne, IN 46845-8871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2017 |
Last Update Date | 17/03/2018 |