Individual
ANDREW MICHAEL BENEDUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
450 S LANDMARK AVE, BLOOMINGTON, IN 47403-5000
(855) 324-0885
(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
1-22-57664
IN
106S00000X
Behavior Technician
RBT-21-184787
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-22-57664
BOARD CERTIFIED BEHAVIOR ANALYST
IN
Enumeration date
09/14/2021
Last updated
02/03/2022
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