Most Relevant Information
Provider Data
| NPI Number: | 1003429770 |
| Provider Name: | SAMANTHA JO BRENNEMAN BA |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: | RBT-19-103437 |
Most Important Dates
| Enumeration Date: | 08/24/2020 |
| Last Updated: | 08/24/2020 |
Provider Practice Location
3781 BAYLEY DR STE B
LAFAYETTE
IN
479058657
Practice Location Phone/Fax
| Phone: | 7652014767 |
| Fax: | 3175208200 |
Provider Mailing Location
3500 DEPAUW BLVD STE 3070
INDIANAPOLIS
IN
462686135
Provider Mailing Phone/Fax
| Phone: | 8553240885 |
| Fax: | 3175208200 |