Provider Demographics
NPI:1417186180
Name:ANDERSON, LIZBETH ANN (MS, BCBA)
Entity Type:Individual
Prefix:MS
First Name:LIZBETH
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9419 SILVERFOX DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7714
Mailing Address - Country:US
Mailing Address - Phone:260-348-7007
Mailing Address - Fax:260-432-7086
Practice Address - Street 1:9419 SILVERFOX DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-7714
Practice Address - Country:US
Practice Address - Phone:260-348-7007
Practice Address - Fax:260-432-7086
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst