Individual
AUDIANNA BASCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
29101 N STATE ROAD 19, ATLANTA, IN 46031-9443
(317) 918-2689
Mailing address
29101 N STATE ROAD 19, ATLANTA, IN 46031-9443
(317) 918-2689
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/31/2022
Last updated
03/24/2025
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