Provider Demographics
NPI:1407576986
Name:HUFFMAN, CASSANDRA GRACE (RBT)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:GRACE
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 LENNOX RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47868-7087
Mailing Address - Country:US
Mailing Address - Phone:812-201-5136
Mailing Address - Fax:
Practice Address - Street 1:5125 DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-9570
Practice Address - Country:US
Practice Address - Phone:317-618-4041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBACB619342103K00000X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst