Healthcare Provider Details

I. General information

NPI: 1285200253
Provider Name (Legal Business Name): ANGELA K CAUDILL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 GARWOOD PL
RICHMOND IN
47374-6069
US

IV. Provider business mailing address

4440 GARWOOD PL
RICHMOND IN
47374-6069
US

V. Phone/Fax

Practice location:
  • Phone: 765-987-5437
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: