Provider Demographics
NPI:1588116529
Name:DEKEMPER, GRACE (BCBA)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:DEKEMPER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:DEKEMPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:1980 E WOODSMALL DR
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4937
Mailing Address - Country:US
Mailing Address - Phone:812-231-5218
Mailing Address - Fax:812-231-5205
Practice Address - Street 1:1900 STRINGTOWN RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-4522
Practice Address - Country:US
Practice Address - Phone:812-490-2826
Practice Address - Fax:812-490-5613
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-16-23811103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst