Provider Demographics
NPI:1073005047
Name:STANISZ, TERRI ELIZABETH (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:ELIZABETH
Last Name:STANISZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:TERRI
Other - Middle Name:ELIZABETH
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:6060 N COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-1907
Mailing Address - Country:US
Mailing Address - Phone:317-584-5166
Mailing Address - Fax:317-815-3861
Practice Address - Street 1:301 SATORI PKWY
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-6406
Practice Address - Country:US
Practice Address - Phone:317-584-5166
Practice Address - Fax:317-815-3861
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst