Provider Demographics
NPI:1437438314
Name:MAGNUSEN, ABBY (BCBA)
Entity Type:Individual
Prefix:
First Name:ABBY
Middle Name:
Last Name:MAGNUSEN
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 1:2110 EMERALD PINES LANE
Mailing Address - Street 2:
Mailing Address - City:WESTFILED
Mailing Address - State:IN
Mailing Address - Zip Code:46074
Mailing Address - Country:US
Mailing Address - Phone:317-379-3828
Mailing Address - Fax:
Practice Address - Street 1:2110 EMERALD PINES LN
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9385
Practice Address - Country:US
Practice Address - Phone:317-379-3828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-10
Last Update Date:2011-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1118081103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst