Individual
MARGO FRANCES SHINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
EDS, BCBA
Contact information
Practice address
2521 E SANDBERG CT, BLOOMINGTON, IN 47401-8572
(206) 765-0679
Mailing address
2521 E SANDBERG CT, BLOOMINGTON, IN 47401-8572
(206) 765-0679
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-50184
IN
Other
Enumeration date
11/10/2021
Last updated
11/10/2021
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