MEDICARE: COURTNEY NICOLE JANOWIAK BCBA

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
1	103K00000X	Behavior Analyst	1-19-36064	IN

General Provider Information

NPI Number	:	1003477845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY NICOLE JANOWIAK BCBA

Provider Business Mailing Address
First Line	:	1315 S SHERMAN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-2210
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1315 S SHERMAN DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-2210
Country	:	US
Telephone Number	:	574-302-5013
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2019
Last Update Date	:	04/15/2026

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