Individual
CASEY CORULLO BOERSMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
12219 GOLDEN HARVEST DR, FORT WAYNE, IN 46845-9030
(260) 467-0090
Mailing address
12219 GOLDEN HARVEST DR, FORT WAYNE, IN 46845-9030
(260) 467-0090
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
01/24/2020
Last updated
01/24/2020
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