Healthcare Provider Details

I. General information

NPI: 1427947183
Provider Name (Legal Business Name): ERIN DANIELLE DEPEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2785 CASON ST
LAFAYETTE IN
47904-2843
US

IV. Provider business mailing address

PO BOX 718713
CHICAGO IL
60677-8713
US

V. Phone/Fax

Practice location:
  • Phone: 765-237-9935
  • Fax:
Mailing address:
  • Phone: 765-237-9935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number21173535
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: