Healthcare Provider Details

I. General information

NPI: 1588475826
Provider Name (Legal Business Name): ELIZABETH MARIE STALLSMITH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 ALBRIGHT RD
KOKOMO IN
46902-3996
US

IV. Provider business mailing address

2745 S 900 E
MARION IN
46953-9803
US

V. Phone/Fax

Practice location:
  • Phone: 765-382-8222
  • Fax:
Mailing address:
  • Phone: 765-618-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2831929
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: