Individual
DESTINY ROW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
833 S HALLECK ST, DEMOTTE, IN 46310-8342
(574) 387-4313
Mailing address
1507 GRANT ST, ELKHART, IN 46514-3757
(574) 361-2727
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-23-265946
IN
Other
Enumeration date
02/20/2025
Last updated
04/15/2026
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