Individual
TIFFANY SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
4118 N CLINTON ST, FORT WAYNE, IN 46805-1210
(260) 373-1050
(260) 471-0285
Mailing address
4118 N CLINTON ST, FORT WAYNE, IN 46805-1210
(260) 373-1050
(260) 471-0285
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-14-16224
IN
Other
Enumeration date
01/02/2015
Last updated
01/02/2015
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