NPI 1003429770

Samantha Jo Brenneman, BA

Practitioner Behavior Technician Lafayette, IN

Practice location

Address: 3781 Bayley Dr STE B, Lafayette, IN 47905-8657
Phone: (765) 201-4767
Fax: (317) 520-8200
Mailing address: 3500 Depauw Blvd STE 3070, Indianapolis, IN 46268-6135

Registered specialties

Behavior Technician Primary

Behavioral Health & Social Service Providers Taxonomy 106S00000X Licence RBT-19-103437 (IN)

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Registry record

NPI: 1003429770
Entity type: Individual
Sex (as registered): Female
NPI issued: 24 Aug 2020
Record last updated: 24 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.