Healthcare Provider Details

I. General information

NPI: 1972966984
Provider Name (Legal Business Name): AMBER L HOBBIE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMBER L GASKILL

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 E 54TH ST
INDIANAPOLIS IN
46220-3219
US

IV. Provider business mailing address

12912 COLDWATER RD
FORT WAYNE IN
46845-8870
US

V. Phone/Fax

Practice location:
  • Phone: 317-815-5501
  • Fax: 317-815-3861
Mailing address:
  • Phone: 317-815-5501
  • Fax: 317-815-3861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: