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NPI Code Detail

MEDICARE: JAMIE LYN WISE MA, BCBA, LBA

MEDICARE: JAMIE LYN WISE MA, BCBA, LBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-14-17717IN
2103K00000XBehavior Analyst267498KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-14-17717OTHERBCBA CERTIFICATION

General Provider Information

NPI Number : 1003205543
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAMIE LYN WISE MA, BCBA, LBA
Provider Business Mailing Address
First Line : 3500 DEPAUW BLVD STE 3070
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-6135
Country : US
Telephone Number : 855-324-0885
Fax Number : 317-520-8200
Provider Business Practice Location Address
First Line : 6635 E 21ST ST STE 100
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-2252
Country : US
Telephone Number : 317-608-2824
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2015
Last Update Date : 06/16/2025

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