1649699877 NPI number — MISS CARRIE LYNETTE SPEHEGER BCBA

Table of content: MISS CARRIE LYNETTE SPEHEGER BCBA (NPI 1649699877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649699877 NPI number — MISS CARRIE LYNETTE SPEHEGER BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPEHEGER
Provider First Name:
CARRIE
Provider Middle Name:
LYNETTE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COCHRAN
Provider Other First Name:
CARRIE
Provider Other Middle Name:
LYNETTE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649699877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/22/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3500 DEPAUW BLVD STE 3070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46268-6135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-324-0885
Provider Business Mailing Address Fax Number:
765-450-6664

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3781 BAYLEY DR STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47905-8647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-201-4797
Provider Business Practice Location Address Fax Number:
765-450-6664
Provider Enumeration Date:
04/15/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-14-15898 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1-14-15898 . This is a "BOARD CERTIFICATION" identifier . This identifiers is of the category "OTHER".