Healthcare Provider Details

I. General information

NPI: 1518790682
Provider Name (Legal Business Name): STEPHANIE JO GARMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2024
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5125 DECATUR BLVD STE A
INDIANAPOLIS IN
46241-7511
US

IV. Provider business mailing address

5525 FURNAS CT
INDIANAPOLIS IN
46221-4128
US

V. Phone/Fax

Practice location:
  • Phone: 317-856-5201
  • Fax:
Mailing address:
  • Phone: 317-603-0949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-304580
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: