Healthcare Provider Details

I. General information

NPI: 1174468268
Provider Name (Legal Business Name): GWYNN MEAGHER RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 W 53RD ST
ANDERSON IN
46013-1516
US

IV. Provider business mailing address

3050 E 1100 N
ALEXANDRIA IN
46001-9045
US

V. Phone/Fax

Practice location:
  • Phone: 765-606-4995
  • Fax: 765-274-5260
Mailing address:
  • Phone: 765-606-4995
  • Fax: 765-274-5260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-531263
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: