Individual
SUZANNE R. BAUTISTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NCACII, CADACII
Contact information
Practice address
5230 W 10TH ST, INDIANAPOLIS, IN 46224-6906
(317) 240-2801
(317) 240-2807
Mailing address
5230 W 10TH ST, INDIANAPOLIS, IN 46224-6906
(317) 240-2801
(317) 240-2807
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
0973
IN
171M00000X
Case Manager/Care Coordinator
—
—
171R00000X
Interpreter
—
—
174H00000X
Health Educator
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
12/31/2012
Last updated
12/31/2012
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