Provider Demographics
NPI:1306554076
Name:SULFRIDGE, MARGARET ELYSE (BCBA, COBA)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ELYSE
Last Name:SULFRIDGE
Suffix:
Gender:F
Credentials:BCBA, COBA
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ELYSE
Other - Last Name:SULFRIDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:PO BOX 28
Mailing Address - Street 2:
Mailing Address - City:CECIL
Mailing Address - State:OH
Mailing Address - Zip Code:45821-0028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4935 HILLEGAS RD STE 200
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-1943
Practice Address - Country:US
Practice Address - Phone:260-338-1241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-10
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst