Individual
GINA DAVENPORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
404 E MAIN ST, GREENTOWN, IN 46936-1258
(765) 628-7400
(317) 842-4428
Mailing address
404 E MAIN ST, GREENTOWN, IN 46936-1258
(765) 628-7400
(317) 842-4428
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
IN
Other
Enumeration date
06/26/2012
Last updated
06/26/2012
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