MEDICARE: ASSENT THERAPY ABA

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

General Provider Information

NPI Number	:	1396421277
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSENT THERAPY ABA

Provider Business Mailing Address
First Line	:	9533 WEST LANTERN LN
Second Line	:
City	:	PENDLETON
State	:	IN
Zip	:	46064
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9533 WEST LANTERN LN
Second Line	:
City	:	PENDLETON
State	:	IN
Zip	:	46064
Country	:	US
Telephone Number	:	219-985-5600
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SARAH ELLENWINE
Credential	:
Telephone Number	:	219-985-5600

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	06/26/2023

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Directions to “ASSENT THERAPY ABA ” Practice Location

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