Individual
JULIE PETTIBONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4719 S CALHOUN ST, FORT WAYNE, IN 46807-2811
(260) 579-6248
Mailing address
4719 S CALHOUN ST, FORT WAYNE, IN 46807-2811
(260) 579-6248
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
07/29/2019
Last updated
07/29/2019
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