Healthcare Provider Details

I. General information

NPI: 1679042097
Provider Name (Legal Business Name): ANNE ELYSE WINDHAM BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2018
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 W VOORHIS AVE
DELAND FL
32720-5432
US

IV. Provider business mailing address

1104 WOOD LAKE TER
DELAND FL
32720-2567
US

V. Phone/Fax

Practice location:
  • Phone: 386-795-5695
  • Fax: 386-777-3850
Mailing address:
  • Phone: 407-417-0764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-19-35423
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: