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NPI Code Detail

MEDICARE: SECOND STEPS, LLC

MEDICARE: SECOND STEPS, LLC
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 Analyst

General Provider Information

NPI Number : 1174830285
Entity Type Code : Organization
Provider Name (Legal Business Name) : SECOND STEPS, LLC
Provider Business Mailing Address
First Line : 4118 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-1210
Country : US
Telephone Number : 260-493-3400
Fax Number : 260-749-2731
Provider Business Practice Location Address
First Line : 4118 N CLINTON ST
Second Line :
City : FORT WAYNE
State : IN
Zip : 46805-1210
Country : US
Telephone Number : 260-493-3400
Fax Number : 260-749-2731
Authorized Official
Title or Position : OWNER
Name : MRS. LISA COMPTON
Credential :
Telephone Number : 260-493-3400
Provider Enumeration Date : 09/10/2010
Last Update Date : 09/26/2012

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Directions to “SECOND STEPS, LLC ” Practice Location

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