Individual
JAMIE LYN WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA, LBA
Contact information
Practice address
6635 E 21ST ST STE 100, INDIANAPOLIS, IN 46219-2252
(317) 608-2824
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-17717
IN
103K00000X
Behavior Analyst
267498
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-14-17717
BCBA CERTIFICATION
—
Enumeration date
01/21/2015
Last updated
06/16/2025
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