JULIE PETTIBONE


Address: 4719 S Calhoun St, Fort Wayne, IN 46807-2811
Phone: 2605796248

JULIE PETTIBONE (NPI# 1790339737) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1790339737
Entity Type Individual
Full Name JULIE PETTIBONE
Practice Address 4719 S Calhoun St
Fort Wayne
IN 46807-2811
Practice Telephone 2605796248
Mailing Telephone 2605796248
Enumeration Date 2019-07-29
Last Update Date 2019-07-29
Gender Code F
Is Sole Proprietor Y

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 103K00000X Behavioral Analyst Behavioral Health & Social Service Providers

Office Location

Street Address 4719 S CALHOUN ST
City FORT WAYNE
State IN
Zip Code 46807-2811

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1982234191 Erin Hall Case Manager/Care Coordinator 5800 Faifield, Fort Wayne, IN 46807 2020-01-16
1912208745 Lezly A Scott Counselor 2417 Fairfield Ave., Attn: Lezly Scott, Fort Wayne, IN 46807 2010-11-10
1851749147 Eric Shoemaker Family Medicine 1007 W Rudisill Blvd, Fort Wayne, IN 46807 2016-05-27
1821464603 Emily Nicole Ackerman Physical Therapist 5800 Fairfield Ave, Ste 150, Fort Wayne, IN 46807 2015-08-17
1477639698 John P Crowley Social Worker 2805 Fairfield Ave, Fort Wayne, IN 46807 2006-10-31
1770131948 Donzhae Lee Student in an Organized Health Care Education/Training Program 2510 Thompson Ave, Fort Wayne, IN 46807-1051 2019-08-30
1407919236 The Arc of Northeast Indiana Inc. Intermediate Care Facility, Mentally Retarded 2522 Thompson Ave, Fort Wayne, IN 46807-1051 2006-12-19
1770725244 Clinical Services, LLC Clinic/Center 2315 Broadway, Fort Wayne, IN 46807-1103 2009-03-30
1831252592 Rosie T Milner Nurse Practitioner 2315 Broadway, Fort Wayne, IN 46807-1103 2006-12-17
1558379453 James Curtis Potts Dentist 2703 Broadway, James C Potts Dds, Fort Wayne, IN 46807-1111 2006-08-04
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Taxonomy Information

Taxonomy Code 103K00000X
Grouping Behavioral Health & Social Service Providers
Classification Behavioral Analyst

Taxonomy Definition

A behavior analyst is qualified by at least a master’s degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans.
Notes: Source: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2008: new, 1/1/2016: modified definition]

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1689204042 Casey Corullo Boersma Behavioral Analyst 12219 Golden Harvest Dr, Fort Wayne, IN 46845-9030 2020-01-24
1063077535 Pathway Aba LLC Behavioral Analyst 5651 Coventry Ln Ste 226, Fort Wayne, IN 46804-7145 2019-05-09
1114495835 Amy Sheefel Behavioral Analyst 201 E Rudisill Blvd Ste B100, Fort Wayne, IN 46806-1738 2018-11-12
1336651736 Great Heights Aba Inc. Behavioral Analyst 343 W Suttenfield St, Fort Wayne, IN 46807-1339 2017-10-26
1851819759 Chelsea Wahl-bridge Behavioral Analyst 2270 Lake Ave Ste 101, Fort Wayne, IN 46805-5360 2017-08-31
1811437999 Jessica Ann Lefever Behavioral Analyst 3898 New Vision Dr Ste D, Fort Wayne, IN 46845 2017-03-08
1831542380 Small Steps - Giant Leaps, Inc. Behavioral Analyst 7429 Nature Trail Dr, Fort Wayne, IN 46835-1425 2016-07-20
1497116578 Brenton Cox Behavioral Analyst 3948 New Vision Dr, Suite D, Fort Wayne, IN 46845-1720 2016-03-16
1700241866 Wendy Renee Boehm Behavioral Analyst 7631 Lakeridge Dr, Fort Wayne, IN 46819-1969 2015-12-16
1316302565 Dewayna Watts Behavioral Analyst 10313 Aboite Center Road, Fort Wayne, IN 46804 2015-12-15
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City FORT WAYNE
Zip Code 46807

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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