Individual
ANTIGONI JAYNE DORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, RBT
Contact information
Practice address
227 W GRIMES LN, BLOOMINGTON, IN 47403
(812) 322-0313
(812) 610-1814
Mailing address
PO BOX 668, BLOOMINGTON, IN 47402
(812) 269-2587
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-24-76736
IN
106S00000X
Behavior Technician
RBT-19-83678
IN
Other
Enumeration date
10/02/2020
Last updated
11/21/2024
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