Provider Demographics
NPI:1376009670
Name:MILLIGAN, NAOMI (BCBA)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:MILLIGAN
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 1:52694 EAST TRL
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-7703
Mailing Address - Country:US
Mailing Address - Phone:219-242-1660
Mailing Address - Fax:
Practice Address - Street 1:701 N NILES AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-1923
Practice Address - Country:US
Practice Address - Phone:574-302-4669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-12
Last Update Date:2022-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-21-56324103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst