Healthcare Provider Details

I. General information

NPI: 1821504879
Provider Name (Legal Business Name): KIRK ALLEN GRABER BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 12/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 W TAPP RD
BLOOMINGTON IN
47403-3278
US

IV. Provider business mailing address

2101 W TAPP RD
BLOOMINGTON IN
47403-3278
US

V. Phone/Fax

Practice location:
  • Phone: 812-330-4460
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-28731
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: