Individual
LESLIE TRUMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.A., BCBA
Contact information
Practice address
51960 GUMWOOD RD, GRANGER, IN 46530-6207
(574) 247-4665
Mailing address
51960 GUMWOOD RD, GRANGER, IN 46530-6207
(574) 247-4665
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-16-23718
BEHAVIOR ANALYSIS CERTIFICATION BOARD
IN
Enumeration date
10/04/2016
Last updated
10/04/2016
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