Individual
MISS MADELEINE JAN WHITAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
9810 BLUEGRASS PKWY, JEFFERSONTOWN, KY 40299-1906
(502) 473-7219
Mailing address
6608 CAMERON DR, CHARLESTOWN, IN 47111-8790
(812) 987-3807
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
11938841
IN
Other
Enumeration date
02/24/2020
Last updated
02/24/2020
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