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NPI Code Detail

MEDICARE: SHELLEY GORSKI BCABA, NCC

MEDICARE: SHELLEY GORSKI BCABA, NCC
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 Analyst
2106E00000XAssistant Behavior Analyst0-15-6722

General Provider Information

NPI Number : 1548626963
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLEY GORSKI BCABA, NCC
Provider Business Mailing Address
First Line : 58160 PECAN RD
Second Line :
City : SOUTH BEND
State : IN
Zip : 46619-9620
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 750 LINCOLN WAY E
Second Line :
City : SOUTH BEND
State : IN
Zip : 46601-3250
Country : US
Telephone Number : 574-786-0088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/14/2016
Last Update Date : 02/13/2025

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Directions to “ SHELLEY GORSKI BCABA, NCC” Practice Location

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