Healthcare Provider Details

I. General information

NPI: 1932053295
Provider Name (Legal Business Name): JULIE ANN SMITH BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8707 W US HIGHWAY 36
MODOC IN
47358-9583
US

IV. Provider business mailing address

5424 N 400 W
WINCHESTER IN
47394-8939
US

V. Phone/Fax

Practice location:
  • Phone: 765-853-5464
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15508
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: