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General NPI Number Information
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NPI Number | 1972318988
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Entity Type | Individual
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Provider Name | KENNEDY MILYNN BANDY RBT
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Gender | Female
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Dates
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Enumeration Date | 02/08/2025
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Last Update Date | 02/08/2025
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Provider Practice Location Address
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Address Line | 1100 EAGLE RIDGE DR
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City | SCHERERVILLE
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State | IN
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Zip | 46375-2897
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Country | US
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Telephone | 219-865-5437
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Fax |
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Provider Business Mailing Address
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Address Line | 314 W 3RD ST
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City | HOBART
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State | IN
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Zip | 46342-4205
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Country | US
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Telephone | 219-707-2658
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Fax |
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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 | 247200000X
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Taxonomy Name | Other Technician
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License Number | BCBA1086511
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License Number State | IN
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