MEDICARE: NORMA ANGELICA BRISENO ALONSO

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	103K00000X	Behavior Analyst	1-23-68351	IN

General Provider Information

NPI Number	:	1285104802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NORMA ANGELICA BRISENO ALONSO

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:	317-520-8200

Provider Business Practice Location Address
First Line	:	17551 GENERATIONS DR
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46635-1589
Country	:	US
Telephone Number	:	574-400-2169
Fax Number	:	317-520-8200

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

Provider Enumeration Date	:	11/26/2018
Last Update Date	:	03/19/2026

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