Individual
HALLIE SHOCKOME
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
5601 COVENTRY LN, FORT WAYNE, IN 46804-7145
(260) 459-6040
Mailing address
5601 COVENTRY LN, FORT WAYNE, IN 46804-7145
(260) 459-6040
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-23-64225
IN
Other
Enumeration date
03/13/2023
Last updated
02/17/2025
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