Healthcare Provider Details

I. General information

NPI: 1073461661
Provider Name (Legal Business Name): ALIYAH RACHELLE VANWINKLE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

556 SOUTH WASHINGTON ST
DALE IN
47523
US

IV. Provider business mailing address

1923 S LIBERTY DR
BLOOMINGTON IN
47403-5146
US

V. Phone/Fax

Practice location:
  • Phone: 812-330-4460
  • Fax: 812-330-4461
Mailing address:
  • Phone: 812-330-4460
  • Fax: 812-330-4461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-522874
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: