Provider Demographics
NPI:1659858652
Name:IANUCILLI, BRITTANY R (RBT)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:R
Last Name:IANUCILLI
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10313 ABOITE CENTER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-5435
Mailing Address - Country:US
Mailing Address - Phone:260-459-6040
Mailing Address - Fax:260-459-6010
Practice Address - Street 1:1200 W DEPOY DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA CITY
Practice Address - State:IN
Practice Address - Zip Code:46725
Practice Address - Country:US
Practice Address - Phone:260-459-6040
Practice Address - Fax:260-459-6010
Is Sole Proprietor?:No
Enumeration Date:2018-07-23
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician