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NPI Code Detail

MEDICARE: MICHELLE HICKMAN BCBA

MEDICARE: MICHELLE HICKMAN 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 Analyst11415860IN

General Provider Information

NPI Number : 1225447097
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE HICKMAN BCBA
Provider Business Mailing Address
First Line : 3901 W 86TH ST STE 397
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-1799
Country : US
Telephone Number : 317-334-7331
Fax Number : 317-334-7336
Provider Business Practice Location Address
First Line : 3901 W 86TH ST STE 397
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46268-1799
Country : US
Telephone Number : 317-334-7331
Fax Number : 317-334-7336
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2014
Last Update Date : 08/06/2014

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