MEDICARE: UNLOCKING THE SPECTRUM

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	222Q00000X	Developmental Therapist
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679895718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNLOCKING THE SPECTRUM

Provider Business Mailing Address
First Line	:	5556 N MERIDIAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-2658
Country	:	US
Telephone Number	:	317-334-7331
Fax Number	:	317-334-7336

Provider Business Practice Location Address
First Line	:	8646 GUION RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3011
Country	:	US
Telephone Number	:	317-334-7331
Fax Number	:	317-334-7336

Authorized Official
Title or Position	:	FOUNDER
Name	:	MRS. ILANA B HERNANDEZ-RITTER
Credential	:
Telephone Number	:	812-606-4413

Provider Enumeration Date	:	02/16/2010
Last Update Date	:	10/28/2019

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Directions to “UNLOCKING THE SPECTRUM ” Practice Location

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