Provider Demographics
NPI:1366982720
Name:MELTZER, KATHLEEN MARIE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARIE
Last Name:MELTZER
Suffix:
Gender:F
Credentials:MA, BCBA
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Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:6635 EAST 21ST STREET
Practice Address - Street 2:SUITE 100, WEST BUILDING
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2254
Practice Address - Country:US
Practice Address - Phone:317-608-2824
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-18-31880OtherBCBA CERTIFICATE