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NPI Code Detail

MEDICARE: EVELYN SOBCZAK BCBA

MEDICARE: EVELYN SOBCZAK 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 Analyst7401001190MI

General Provider Information

NPI Number : 1477162279
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVELYN SOBCZAK BCBA
Provider Business Mailing Address
First Line : 1550 PIDCO DR
Second Line :
City : PLYMOUTH
State : IN
Zip : 46563-1355
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1550 PIDCO DR
Second Line :
City : PLYMOUTH
State : IN
Zip : 46563-1355
Country : US
Telephone Number : 574-387-4309
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2020
Last Update Date : 02/02/2026

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Directions to “ EVELYN SOBCZAK BCBA” Practice Location

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