Provider Demographics
NPI:1649699877
Name:SPEHEGER, CARRIE LYNETTE (BCBA)
Entity type:Individual
Prefix:MISS
First Name:CARRIE
Middle Name:LYNETTE
Last Name:SPEHEGER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:LYNETTE
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:765-450-6664
Practice Address - Street 1:3781 BAYLEY DR STE B
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8647
Practice Address - Country:US
Practice Address - Phone:765-201-4797
Practice Address - Fax:765-450-6664
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-14-15898103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-14-15898OtherBOARD CERTIFICATION