Provider Demographics
NPI:1790595775
Name:WINEGARDNER, CARLA SUE (MA, BCBA)
Entity type:Individual
Prefix:MS
First Name:CARLA
Middle Name:SUE
Last Name:WINEGARDNER
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 N 175 E
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-7376
Mailing Address - Country:US
Mailing Address - Phone:574-551-5500
Mailing Address - Fax:
Practice Address - Street 1:801 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1842
Practice Address - Country:US
Practice Address - Phone:574-457-3188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-10
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBACB845745103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst