Most Relevant Information
Provider Data
| NPI Number: | 1003552050 |
| Provider Name: | LYDIA HALL BCBA |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: | 1-22-59510 |
Most Important Dates
| Enumeration Date: | 05/11/2022 |
| Last Updated: | 05/11/2022 |
Provider Practice Location
601 NOBLE DR
FORT WAYNE
IN
468255544
Practice Location Phone/Fax
| Phone: | 2604209332 |
| Fax: |
Provider Mailing Location
12519 GREAT PINES CV
FORT WAYNE
IN
468459565
Provider Mailing Phone/Fax
| Phone: | 2602415796 |
| Fax: |