Individual
BIANCA WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2849 WOLFGANG DR, INDIANAPOLIS, IN 46239-7946
(317) 400-7163
Mailing address
2849 WOLFGANG DR, INDIANAPOLIS, IN 46239-7946
(317) 400-7163
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
374700000X
Technician
—
IN
3747A0650X
Attendant Care Provider
Primary
—
IN
3747P1801X
Personal Care Attendant
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
719
—
IN
Enumeration date
10/09/2024
Last updated
10/09/2024
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