Basic Information
| Provider Information | |||||||||
| NPI: | 1588116529 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEKEMPER | ||||||||
| FirstName: | GRACE | ||||||||
| MiddleName: | |||||||||
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| Credential: | BCBA | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | DEKEMPER | ||||||||
| OtherFirstName: | GRACE | ||||||||
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| OtherCredential: | BCBA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1980 E WOODSMALL DR | ||||||||
| Address2: | |||||||||
| City: | TERRE HAUTE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 478024937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122315218 | ||||||||
| FaxNumber: | 8122315205 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 STRINGTOWN RD | ||||||||
| Address2: | |||||||||
| City: | EVANSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 477114522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8124902826 | ||||||||
| FaxNumber: | 8124905613 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/25/2016 | ||||||||
| LastUpdateDate: | 01/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-16-23811 | IN | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.