Provider Demographics
NPI:1336751031
Name:MCGRUDER, KERI ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:ANN
Last Name:MCGRUDER
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 1:5330 MARTIN LTHR KNG JR BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-6601
Mailing Address - Country:US
Mailing Address - Phone:765-606-4995
Mailing Address - Fax:765-374-0652
Practice Address - Street 1:5330 MARTIN LTHR KNG JR BLVD STE B
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-6601
Practice Address - Country:US
Practice Address - Phone:765-606-4995
Practice Address - Fax:765-374-0652
Is Sole Proprietor?:No
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst