Provider Demographics
NPI:1366848186
Name:FRIES, REBECCA ANNE (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:FRIES
Suffix:
Gender:F
Credentials:MA, BCBA
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Mailing Address - Street 1:3500 DEPAUW BOULEVARD
Mailing Address - Street 2:SUITE 3070
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:765-450-6664
Practice Address - Street 1:21 S PARK BLVD
Practice Address - Street 2:SUITE 21
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-8838
Practice Address - Country:US
Practice Address - Phone:317-449-2104
Practice Address - Fax:765-450-6664
Is Sole Proprietor?:No
Enumeration Date:2014-11-05
Last Update Date:2017-02-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN1-14-10133103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-14-10133OtherBCBA