Provider Demographics
NPI:1316381585
Name:LEIPZIG, ANNE KATHERINE (BCBA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:KATHERINE
Last Name:LEIPZIG
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 1:9929 E 126TH ST
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-9404
Mailing Address - Country:US
Mailing Address - Phone:317-436-8961
Mailing Address - Fax:317-436-8966
Practice Address - Street 1:11902 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1308
Practice Address - Country:US
Practice Address - Phone:317-436-8961
Practice Address - Fax:317-436-8966
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-12-12304103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst