Individual
MARY ELLEN DICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
9905 FALL CREEK RD, INDIANAPOLIS, IN 46256-4804
(317) 813-4690
Mailing address
9905 FALL CREEK RD, INDIANAPOLIS, IN 46256-4804
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-41073
IN
106S00000X
Behavior Technician
RBT-17-34375
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300050744
—
IN
Enumeration date
04/03/2018
Last updated
06/09/2025
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