Individual
LACY MARIE WOLTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
17390 DUGDALE DR STE 100, SOUTH BEND, IN 46635-1512
(574) 400-2169
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-24012
IN
Other
Enumeration date
04/30/2015
Last updated
02/25/2022
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