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NPI Code Detail

MEDICARE: LAURA GRANT BCBA

MEDICARE: LAURA GRANT 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 Analyst

General Provider Information

NPI Number : 1811295793
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAURA GRANT BCBA
Provider Business Mailing Address
First Line : 1026 DARROW AVE
Second Line :
City : EVANSTON
State : IL
Zip : 60202-1110
Country : US
Telephone Number : 317-966-3300
Fax Number :
Provider Business Practice Location 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
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/02/2011
Last Update Date : 05/27/2022

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Directions to “ LAURA GRANT BCBA” Practice Location

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