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NPI Code Detail

MEDICARE: MICHELLE GROSE BCABA

MEDICARE: MICHELLE GROSE BCABA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1215360029
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE GROSE BCABA
Provider Business Mailing Address
First Line : 7901 E 88TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-1235
Country : US
Telephone Number : 317-849-5437
Fax Number : 317-842-5911
Provider Business Practice Location Address
First Line : 3435 W 96TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-1102
Country : US
Telephone Number : 317-802-7447
Fax Number : 317-802-7325
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2013
Last Update Date : 06/14/2019

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