Provider Demographics
NPI:1528608478
Name:VELASCO, FELICIA
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:VELASCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:FELICIA
Other - Middle Name:
Other - Last Name:VELASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 N LAKE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOBART
Mailing Address - State:IN
Mailing Address - Zip Code:46342-3058
Mailing Address - Country:US
Mailing Address - Phone:219-299-0831
Mailing Address - Fax:
Practice Address - Street 1:400 N LAKE PARK AVE
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:IN
Practice Address - Zip Code:46342-3058
Practice Address - Country:US
Practice Address - Phone:219-299-0831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician