Healthcare Provider Details

I. General information

NPI: 1407518327
Provider Name (Legal Business Name): MARLEAH KAITLYN FOSSETT BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 04/18/2026
Certification Date: 04/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 E ARBOR AVE BLDG 3
MESA AZ
85206-6107
US

IV. Provider business mailing address

10370 HOMESTEAD DR
BROWNSBURG IN
46112-7443
US

V. Phone/Fax

Practice location:
  • Phone: 720-706-3396
  • Fax:
Mailing address:
  • Phone: 317-341-5686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79780
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: