Individual
ADDISON BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6131 N CLINTON ST, FORT WAYNE, IN 46825-4905
(260) 459-6040
Mailing address
5601 COVENTRY LN, FORT WAYNE, IN 46804-7145
(260) 459-6040
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-109056
IN
Other
Enumeration date
09/16/2024
Last updated
09/16/2024
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