MEDICARE: LAURA MARIE BRITTON 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	1-12-12316	IN

General Provider Information

NPI Number	:	1730428350
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MARIE BRITTON BCBA

Provider Business Mailing Address
First Line	:	4619 COVENTRY PKWY
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-7111
Country	:	US
Telephone Number	:	260-750-5480
Fax Number	:

Provider Business Practice Location Address
First Line	:	12912 COLDWATER RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-8870
Country	:	US
Telephone Number	:	260-245-1455
Fax Number	:	317-815-3861

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

Provider Enumeration Date	:	02/01/2013
Last Update Date	:	05/09/2019

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