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NPI Code Detail

MEDICARE: CORI KEEN MA, BCBA

MEDICARE: CORI KEEN MA, 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 Analyst1-21-50509IN
2106S00000XBehavior Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11-21-50509OTHERINBCBA SUPERVISORY CERTIFICATION
21-21-50509OTHERINBCBA CERTIFICATION

General Provider Information

NPI Number : 1669972493
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORI KEEN MA, BCBA
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 : 317-520-8200
Provider Business Practice Location Address
First Line : 6925 PARKDALE PL
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46254-4673
Country : US
Telephone Number : 317-597-4553
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2018
Last Update Date : 07/25/2022

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