Healthcare Provider Details

I. General information

NPI: 1548626963
Provider Name (Legal Business Name): SHELLEY GORSKI BCABA, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 LINCOLN WAY E
SOUTH BEND IN
46601-3250
US

IV. Provider business mailing address

58160 PECAN RD
SOUTH BEND IN
46619-9620
US

V. Phone/Fax

Practice location:
  • Phone: 574-786-0088
  • 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
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-15-6722
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: