Provider Demographics
NPI:1053183673
Name:NI, AMY
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:NI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10459 KENSINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-2594
Mailing Address - Country:US
Mailing Address - Phone:317-270-7699
Mailing Address - Fax:
Practice Address - Street 1:5125 DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-9570
Practice Address - Country:US
Practice Address - Phone:317-856-5201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-26
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician