MEDICARE: DANYELL LOUISE LINDBO 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

General Provider Information

NPI Number	:	1033644042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANYELL LOUISE LINDBO BCBA

Provider Business Mailing Address
First Line	:	1441 EAST BROAD STREET
Second Line	:	#90
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-1968
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 EAST BROAD STREET
Second Line	:	#90
City	:	FUQUAY VARINA
State	:	NC
Zip	:	27526-1968
Country	:	US
Telephone Number	:	855-832-6727
Fax Number	:

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

Provider Enumeration Date	:	04/27/2017
Last Update Date	:	10/30/2025

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