Provider Demographics
NPI:1073028080
Name:BROADWELL, KATHERINE LINDSEY (MED, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LINDSEY
Last Name:BROADWELL
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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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 1:2740 SAINT ANDREWS DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-6684
Practice Address - Country:US
Practice Address - Phone:615-632-2003
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2017-12-13
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-19-40322103K00000X
TN1253103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ083343Medicaid