Active NPI
Trisa Immroth
- Behavior Technician
- Fort Wayne, IN
National Provider Identifier
1194514893
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 4422 E State Blvd
Fort Wayne, IN 46815-6917 - Phone
- (260) 471-9263
- NPI assigned
- May 1, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
4422 E State Blvd
Fort Wayne, IN 46815-6917
Mailing address
3500 Depauw Blvd Ste 3070
Indianapolis, IN 46268-6135
Phone (855) 324-0885
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1746057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1746057600000",
"number": "1194514893",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3500 DEPAUW BLVD STE 3070",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462686135",
"telephone_number": "855-324-0885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4422 E STATE BLVD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468156917",
"telephone_number": "260-471-9263"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IMMROTH",
"first_name": "TRISA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-05-01",
"last_updated": "2025-05-01",
"certification_date": "2025-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.