Healthcare Provider Details

I. General information

NPI: 1568298941
Provider Name (Legal Business Name): HANNELE BURCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 S LIBERTY DR STE 410
BLOOMINGTON IN
47403-5178
US

IV. Provider business mailing address

1701 LIBRARY BLVD STE A
GREENWOOD IN
46142-1567
US

V. Phone/Fax

Practice location:
  • Phone: 812-200-2777
  • Fax:
Mailing address:
  • Phone: 317-881-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: