Individual
BROOKE SHIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
12938 COLDWATER RD, FORT WAYNE, IN 46845-9517
(317) 815-5501
Mailing address
9923 NORTHBROOK VALLEY DR APT 1, FORT WAYNE, IN 46825-2373
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
10/16/2025
Last updated
10/16/2025
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