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NPI Code Detail

MEDICARE: KRISTA DIANE GRITZMAKER MA, BCBA

MEDICARE: KRISTA DIANE GRITZMAKER 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 Analyst1-21-52773IN

General Provider Information

NPI Number : 1861005100
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTA DIANE GRITZMAKER 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 : 505 S 3RD ST
Second Line :
City : ELKHART
State : IN
Zip : 46516-3252
Country : US
Telephone Number : 574-359-6796
Fax Number : 317-520-8200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2020
Last Update Date : 11/12/2021

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