NPI 1700549821 · live from the CMS NPI Registry
Mckenzie T Bacon, MS, BCBA
Behavior Analyst in Springfield, MO. National Provider Identifier 1700549821, active.
NPI record
| NPI | 1700549821 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Behavior Analyst 103K00000X |
| Practice location | 1300 E Bradford Pkwy Bldg B, Springfield, MO 65804 |
| Practice phone | 417-761-5000 |
| Mailing address | 1300 E Bradford Pkwy, Springfield, MO 65804 |
| Enumerated | October 15, 2021 |
| Last updated | June 11, 2025 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Behavior Analyst primary | 103K00000X | 2021039670 (MO) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.