=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831542380
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMALL STEPS - GIANT LEAPS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2016
-----------------------------------------------------
Last Update Date | 07/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7429 NATURE TRAIL DR
-----------------------------------------------------
City | FORT WAYNE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46835-1425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-445-0673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 15368
-----------------------------------------------------
City | FORT WAYNE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46885-5368
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-445-0673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. REBECCA NEWMAN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 260-445-0673
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------