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General NPI Number Information
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NPI Number | 1285231357
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Entity Type | Individual
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Provider Name | ANTIGONI JAYNE DORA BA, RBT
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Gender | Female
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 227 W GRIMES LN
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City | BLOOMINGTON
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State | IN
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Zip | 47403
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Country | US
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Telephone | 812-322-0313
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Fax | 812-610-1814
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Provider Business Mailing Address
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Address Line | PO BOX 668
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City | BLOOMINGTON
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State | IN
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Zip | 47402
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Country | US
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Telephone | 812-269-2587
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Fax | 317-520-8200
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-83678
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-76736
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License Number State | IN
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