Individual
ROBERT PETTIBONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
4719 S CALHOUN ST, FORT WAYNE, IN 46807-2811
(260) 705-0522
Mailing address
4719 S CALHOUN ST, FORT WAYNE, IN 46807-2811
(260) 705-0522
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-40238
IN
Other
Enumeration date
12/15/2020
Last updated
08/13/2021
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