Healthcare Provider Details

I. General information

NPI: 1669099537
Provider Name (Legal Business Name): BRITTANY ALBERT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2020
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S LANDMARK AVE
BLOOMINGTON IN
47403-5000
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 812-269-3214
  • Fax:
Mailing address:
  • Phone: 855-324-0885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number20-112158
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: