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NPI Code Detail

MEDICARE: ELIZABETH ROUDEBUSH BCBA

MEDICARE: ELIZABETH ROUDEBUSH 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
1103K00000XBehavior Analyst1-16-24862IN

General Provider Information

NPI Number : 1164969911
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH ROUDEBUSH BCBA
Provider Business Mailing Address
First Line : 9929 E 126TH ST
Second Line :
City : FISHERS
State : IN
Zip : 46038-9404
Country : US
Telephone Number : 317-436-8961
Fax Number : 317-991-1593
Provider Business Practice Location Address
First Line : 6704 CENTRAL BLVD
Second Line :
City : ZIONSVILLE
State : IN
Zip : 46077-7600
Country : US
Telephone Number : 317-769-4335
Fax Number : 317-991-1593
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2017
Last Update Date : 01/31/2017

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