Healthcare Provider Details

I. General information

NPI: 1194533521
Provider Name (Legal Business Name): JENNIFER SHIPMAN RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 H ST
BEDFORD IN
47421-2330
US

IV. Provider business mailing address

PO BOX 668
BLOOMINGTON IN
47402-0668
US

V. Phone/Fax

Practice location:
  • Phone: 812-322-0313
  • Fax:
Mailing address:
  • Phone: 812-322-0313
  • Fax: 812-610-1814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-213682
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: