Individual
SHANNON FIFE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12650 HAMILTON CROSSING BLVD, CARMEL, IN 46032-5400
(317) 249-2242
(317) 663-1175
Mailing address
12650 HAMILTON CROSSING BLVD, CARMEL, IN 46032-5400
(317) 249-2242
(317) 663-1175
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-38620
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-19-38620
BACB CERTIFICATION
IN
Enumeration date
10/22/2019
Last updated
10/22/2019
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