Healthcare Provider Details

I. General information

NPI: 1639547029
Provider Name (Legal Business Name): ANGELA DALE STOKES BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8646 GUION RD
INDIANAPOLIS IN
46268-3011
US

IV. Provider business mailing address

5556 N MERIDIAN ST
INDIANAPOLIS IN
46208-2658
US

V. Phone/Fax

Practice location:
  • Phone: 317-334-7331
  • Fax: 317-334-7336
Mailing address:
  • Phone: 317-334-7331
  • Fax: 317-334-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-15-19058
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: