Organization
FULL SPECTRUM ABA THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAUREN LONG BCBA (EXECUTIVE DIRECTOR)
(317) 318-4352
Entity
Organization
Contact information
Practice address
407 MEADOW AVE, CRAWFORDSVILLE, IN 47933-2718
(317) 318-4352
(765) 217-7151
Mailing address
101 W MAIN ST OFC 217, CRAWFORDSVILLE, IN 47933-1712
(317) 318-4352
(765) 217-7151
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300048511
—
IN
Enumeration date
04/21/2021
Last updated
04/21/2021
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