Provider Demographics
NPI:1215347059
Name:CODY-DA ROSA, CHEYENNE (MED, BCBA, COBA, LBA)
Entity type:Individual
Prefix:MRS
First Name:CHEYENNE
Middle Name:
Last Name:CODY-DA ROSA
Suffix:
Gender:
Credentials:MED, BCBA, COBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DEPAUW BLVD STE 3070
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-6135
Mailing Address - Country:US
Mailing Address - Phone:855-324-0885
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:773 BROOKSEDGE BLVD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2821
Practice Address - Country:US
Practice Address - Phone:614-401-3366
Practice Address - Fax:317-520-8200
Is Sole Proprietor?:No
Enumeration Date:2014-05-01
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBEH-000631103K00000X
OHCOBA.00831103K00000X
OH1-20-44347103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
1-20-44347OtherBCBA CERTIFICATE