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451 S Park Ridge Rd # 102 Bloomington IN 47401-8589 | |
| (812) 747-9384 | |
| (513) 278-5465 |
| Full Name | |
|---|---|
| Speciality | Behavior Analyst |
| Location | 451 S Park Ridge Rd # 102, Bloomington, Indiana |
| Authorized Official Name and Position | Sara Allyn Shrivastav (CEO) |
| Authorized Official Contact | 8127479384 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4101 E 3rd St Bloomington IN 47401-5539 Ph: (812) 747-9384 | 451 S Park Ridge Rd # 102 Bloomington IN 47401-8589 Ph: (812) 747-9384 |
| NPI Number | 1598477879 |
|---|---|
| Provider Enumeration Date | 12/19/2022 |
| Last Update Date | 01/07/2025 |
| Certification Date | 01/07/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598477879 | NPI | - | NPPES |
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