Provider Demographics
NPI:1174414494
Name:VERNON, AIDAN MICHAEL
Entity type:Individual
Prefix:
First Name:AIDAN
Middle Name:MICHAEL
Last Name:VERNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 S SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47396-1641
Mailing Address - Country:US
Mailing Address - Phone:765-717-4483
Mailing Address - Fax:
Practice Address - Street 1:3601 W BETHEL AVE
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5408
Practice Address - Country:US
Practice Address - Phone:765-876-5098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-14
Last Update Date:2025-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician