Individual
MRS. MISTY MARIE CAENEPEEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
2270 LAKE AVENUE, FORT WAYNE, IN 46805
(260) 444-5649
(888) 265-7858
Mailing address
2270 LAKE AVENUE, FORT WAYNE, IN 46805
(260) 444-5649
(888) 265-7858
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-20-44602
BACB CERTIFICATE
IN
Enumeration date
04/26/2021
Last updated
10/18/2024
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