Individual
CONNIE PONCE DE LEON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6603 LIGHTHOUSE DR APT 101, PORTAGE, IN 46368-6908
(219) 318-7366
Mailing address
6603 LIGHTHOUSE DR APT 101, PORTAGE, IN 46368-6908
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
03/16/2026
Last updated
03/16/2026
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