Provider Demographics
NPI:1285231357
Name:DORA, ANTIGONI JAYNE (BA, RBT)
Entity type:Individual
Prefix:
First Name:ANTIGONI
Middle Name:JAYNE
Last Name:DORA
Suffix:
Gender:F
Credentials:BA, RBT
Other - Prefix:
Other - First Name:ANTIGONI
Other - Middle Name:JAYNE
Other - Last Name:TONGRET BOWERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 668
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47402
Mailing Address - Country:US
Mailing Address - Phone:812-269-2587
Mailing Address - Fax:317-520-8200
Practice Address - Street 1:227 W GRIMES LN
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403
Practice Address - Country:US
Practice Address - Phone:812-322-0313
Practice Address - Fax:812-610-1814
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-19-83678106S00000X
IN1-24-76736103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician