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NPI Code Detail

MEDICARE: EMILIE GUSTIN

MEDICARE: EMILIE GUSTIN
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
1171M00000XCase Manager/Care Coordinator
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1164926648
Entity Type Code : Individual
Provider Name (Legal Business Name) : EMILIE GUSTIN
Provider Business Mailing Address
First Line : 1605 S WAYNE ST
Second Line :
City : ANGOLA
State : IN
Zip : 46703-2194
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1605 S WAYNE ST
Second Line :
City : ANGOLA
State : IN
Zip : 46703-2194
Country : US
Telephone Number : 260-243-4720
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2018
Last Update Date : 11/16/2023

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Directions to “ EMILIE GUSTIN ” Practice Location

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