Healthcare Provider Details

I. General information

NPI: 1750183422
Provider Name (Legal Business Name): SYLVIA GOSSARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E RUDISILL BLVD STE 100B
FORT WAYNE IN
46806-1756
US

IV. Provider business mailing address

2377 ROAD 33
PAYNE OH
45880-9656
US

V. Phone/Fax

Practice location:
  • Phone: 260-255-3665
  • Fax:
Mailing address:
  • Phone: 419-231-1895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: