NPI 1063971166 · live from the CMS NPI Registry
Developmental Wellness
Behavior Analyst in Pella, IA. National Provider Identifier 1063971166, active.
NPI record
| NPI | 1063971166 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 910 Washington St, Pella, IA 50219 |
| Practice phone | 515-664-3244 |
| Mailing address | 4912 Walker Cir, Johnston, IA 50131 |
| Enumerated | March 18, 2019 |
| Last updated | August 7, 2023 |
| Authorized official | Kyle Cervone, Owner/Chief Clinical Officer |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Clinic/Center | 261Q00000X | — |
| Behavior Analyst primary | 103K00000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.