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NPI Code Detail

MEDICARE: KENNETH WEADICK BCBA

MEDICARE: KENNETH WEADICK BCBA
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 Analyst1073710IN

General Provider Information

NPI Number : 1588198428
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH WEADICK BCBA
Provider Business Mailing Address
First Line : 360 POLK ST
Second Line :
City : GREENWOOD
State : IN
Zip : 46143-1623
Country : US
Telephone Number : 317-888-1557
Fax Number : 317-888-1571
Provider Business Practice Location Address
First Line : 360 POLK ST
Second Line :
City : GREENWOOD
State : IN
Zip : 46143-1623
Country : US
Telephone Number : 317-888-1557
Fax Number : 317-888-1571
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2017
Last Update Date : 04/18/2017

Similar Medicare Providers

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1891147252 — MALLORY DANIELLE KINGREY BCBA
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Directions to “ KENNETH WEADICK BCBA” Practice Location

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