MEDICARE: JOY THOMPSON 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	1-20-46365	IN

General Provider Information

NPI Number	:	1588233118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOY THOMPSON BCBA

Provider Business Mailing Address
First Line	:	9031 STELLHORN CROSSING PKWY
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-5860
Country	:	US
Telephone Number	:	260-316-4634
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	:	260-316-4634
Fax Number	:

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

Provider Enumeration Date	:	06/18/2021
Last Update Date	:	06/18/2021

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Directions to “ JOY THOMPSON BCBA” Practice Location

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