MEDICARE: DISABILITY AND AUTISM SERVICES OF INDIANA LLC

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	1-08-4008	IN

General Provider Information

NPI Number	:	1710202171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISABILITY AND AUTISM SERVICES OF INDIANA LLC

Provider Business Mailing Address
First Line	:	4561 W COUNTY ROAD 650 N
Second Line	:
City	:	SAINT PAUL
State	:	IN
Zip	:	47272-9742
Country	:	US
Telephone Number	:	812-322-4374
Fax Number	:

Provider Business Practice Location Address
First Line	:	4561 W COUNTY ROAD 650 N
Second Line	:
City	:	SAINT PAUL
State	:	IN
Zip	:	47272-9742
Country	:	US
Telephone Number	:	812-322-4374
Fax Number	:

Authorized Official
Title or Position	:	BOARD CERTIFIED BEHAVIOR ANALYST
Name	:	MRS. LIBBYL A CASWELL
Credential	:	B.C.B.A
Telephone Number	:	812-322-4374

Provider Enumeration Date	:	03/29/2010
Last Update Date	:	03/29/2010

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