Provider Demographics
NPI:1134517642
Name:GARTENMAN, CALLIE ANNE (BCBA)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:ANNE
Last Name:GARTENMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 TOUBY PIKE STE B
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46901-2573
Mailing Address - Country:US
Mailing Address - Phone:765-628-7400
Mailing Address - Fax:765-450-6453
Practice Address - Street 1:1314 N LIBERTY CIR W
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-6647
Practice Address - Country:US
Practice Address - Phone:812-663-2273
Practice Address - Fax:812-663-2275
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-14-17736103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300010170Medicaid