Individual
JORDAN ROSE DEBOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
451 S PARK RIDGE RD STE 102, BLOOMINGTON, IN 47401-8589
(317) 334-7331
(317) 334-7336
Mailing address
5556 N MERIDIAN ST, INDIANAPOLIS, IN 46208-2658
(317) 334-7331
(317) 334-7336
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-19-38674
IN
106S00000X
Behavior Technician
RBT-17-33059
IN
Other
Enumeration date
05/08/2019
Last updated
10/24/2019
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