MEDICARE: RILEY DODSON

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1194674101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY DODSON

Provider Business Mailing Address
First Line	:	3520 ACADEMIC PL APT 303
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-5318
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 ACADEMIC PL APT 303
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46835-5318
Country	:	US
Telephone Number	:	260-205-4116
Fax Number	:	260-205-4116

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

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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Directions to “ RILEY DODSON ” Practice Location

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