Healthcare Provider Details

I. General information

NPI: 1134711799
Provider Name (Legal Business Name): KIAH HAGGARD RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 FOX POINTE DR
COLUMBUS IN
47203-3220
US

IV. Provider business mailing address

3500 DEPAUW BLVD STE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 317-222-1242
  • Fax:
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number96000019A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: