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NPI Code Detail

MEDICARE: HEIDI ALIENE MANN BCBA

MEDICARE: HEIDI ALIENE MANN 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 Analyst1-21-46959IN

General Provider Information

NPI Number : 1669063509
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEIDI ALIENE MANN BCBA
Provider Business Mailing Address
First Line : 1800 W 900 S
Second Line :
City : FLAT ROCK
State : IN
Zip : 47234-9773
Country : US
Telephone Number : 317-512-3063
Fax Number : 317-663-2947
Provider Business Practice Location Address
First Line : 120 W JACKSON ST STE B&C
Second Line :
City : SHELBYVILLE
State : IN
Zip : 46176-1295
Country : US
Telephone Number : 317-512-3063
Fax Number : 317-663-2947
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2021
Last Update Date : 02/02/2021

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Directions to “ HEIDI ALIENE MANN BCBA” Practice Location

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