Healthcare Provider Details

I. General information

NPI: 1376119099
Provider Name (Legal Business Name): ABOVE AND BEYOND ABA IN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5534 SAINT JOE RD
FORT WAYNE IN
46835-3328
US

IV. Provider business mailing address

5534 SAINT JOE RD
FORT WAYNE IN
46835-3328
US

V. Phone/Fax

Practice location:
  • Phone: 317-593-1243
  • Fax:
Mailing address:
  • Phone: 317-593-1243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: MR. MATT ROKOWSKY
Title or Position: AUTHORIZED OFFICIAL
Credential: LNHA
Phone: 317-593-1243