MEDICARE: GWENDOLYN BIENZ 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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1568110856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GWENDOLYN BIENZ BCBA

Provider Business Mailing Address
First Line	:	4029 ARLINGTON AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46807-2307
Country	:	US
Telephone Number	:	260-760-1096
Fax Number	:

Provider Business Practice Location Address
First Line	:	9031 STELLHORN CROSSING PKWY
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5860
Country	:	US
Telephone Number	:	260-338-1241
Fax Number	:

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

Provider Enumeration Date	:	03/15/2022
Last Update Date	:	03/15/2022

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Directions to “ GWENDOLYN BIENZ BCBA” Practice Location

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