Individual ProviderMichaela MacinnisBehavior TechnicianBehavioral Health & Social Service ProvidersPractice Address17390 Dugdale Dr Ste 100, South Bend, IN 46635-1512(574) 400-2169(855) 324-0885PECOS EnrollmentBased on the most recent information from CMS, provider Michaela Macinnis does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:33 PM.Profile DetailsProvider ID1376115634Provider TypeIndividualFull NameMacinnis, MichaelaCredentialRBTGenderFemaleSole ProprietorNoEnumeration Date7/15/2021Last Updated7/15/2021Contact InformationPractice LocationPractice Address17390 Dugdale Dr Ste 100, South Bend, IN 46635-1512Phone(574) 400-2169Fax(317) 520-8200Mailing LocationMailing Address3500 Depauw Blvd Ste 3070, Indianapolis, IN 46268-6135Phone(855) 324-0885Fax(317) 520-8200Provider TaxonomiesCodeDescriptionLicenseCode106S00000XPrimaryDescriptionBehavior TechnicianBehavioral Health & Social Service ProvidersLicenseRBT-21-175849Indiana