Provider Demographics
NPI:1831689256
Name:INDGE, ADRIENNE (BCBA)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:
Last Name:INDGE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9959 E PEAKVIEW AVE APT N104
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80111-6116
Mailing Address - Country:US
Mailing Address - Phone:303-408-7043
Mailing Address - Fax:
Practice Address - Street 1:12503 E EUCLID DR STE 55
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-6466
Practice Address - Country:US
Practice Address - Phone:303-408-7043
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-10
Last Update Date:2023-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17-39935106S00000X
CO1-23-68349103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician