MEDICARE: AYANNA CAMPBELL

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1598628570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYANNA CAMPBELL

Provider Business Mailing Address
First Line	:	3500 DEPAUW BLVD STE 3070
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-6135
Country	:	US
Telephone Number	:	855-324-0885
Fax Number	:

Provider Business Practice Location Address
First Line	:	2620 KESSLER BOULEVARD EAST DR STE 105
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2889
Country	:	US
Telephone Number	:	317-777-6590
Fax Number	:

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

Provider Enumeration Date	:	12/05/2025
Last Update Date	:	12/05/2025

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Directions to “ AYANNA CAMPBELL ” Practice Location

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