Individual
ALEXCIS ABBOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
202 E FRANKLIN ST, ST. PAUL, IN 47272
(317) 512-0683
Mailing address
202 E FRANKLIN ST, ST. PAUL, IN 47272
(317) 512-0683
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LOA134038321001
BLUECROSS BLUESHIELD
—
Enumeration date
05/06/2022
Last updated
05/06/2022
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