Provider Demographics
NPI:1659032217
Name:WANNINGER, HILLORI LAYNE (BCBA)
Entity Type:Individual
Prefix:
First Name:HILLORI
Middle Name:LAYNE
Last Name:WANNINGER
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 1:12354 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5807
Mailing Address - Country:US
Mailing Address - Phone:317-503-1296
Mailing Address - Fax:
Practice Address - Street 1:12354 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5807
Practice Address - Country:US
Practice Address - Phone:317-503-1296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INBACB541611103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst