MEDICARE: ANDREA DUDDING

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	RBT-14-00174	OH

General Provider Information

NPI Number	:	1407245137
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA DUDDING

Provider Business Mailing Address
First Line	:	1209 HILL RD N
Second Line	:	PMB 176
City	:	PICKERINGTON
State	:	OH
Zip	:	43147-8888
Country	:	US
Telephone Number	:	740-739-3693
Fax Number	:

Provider Business Practice Location Address
First Line	:	608 PHILLIPS DR
Second Line	:
City	:	BEAVERCREEK TOWNSHIP
State	:	OH
Zip	:	45434-7230
Country	:	US
Telephone Number	:	614-949-9102
Fax Number	:

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

Provider Enumeration Date	:	01/19/2015
Last Update Date	:	01/19/2015

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