1518253590 NPI number — MS. ABIGAIL LEAH KOENIG BCBA

Table of content: MS. ABIGAIL LEAH KOENIG BCBA (NPI 1518253590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518253590 NPI number — MS. ABIGAIL LEAH KOENIG BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOENIG
Provider First Name:
ABIGAIL
Provider Middle Name:
LEAH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAMPBELL
Provider Other First Name:
ABIGAIL
Provider Other Middle Name:
LEAH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518253590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10650 E BETHANY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80014-2653
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-433-8339
Provider Business Mailing Address Fax Number:
303-957-2251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 ISABEL CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUENA VISTA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81211-9551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-422-8339
Provider Business Practice Location Address Fax Number:
303-957-2251
Provider Enumeration Date:
06/28/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-12-11685 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21020388 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".