1457826802 NPI number — MRS. JOSIE MARIE HUPP M.ED, BCBA

Table of content: MRS. JOSIE MARIE HUPP M.ED, BCBA (NPI 1457826802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457826802 NPI number — MRS. JOSIE MARIE HUPP M.ED, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HUPP
Provider First Name:
JOSIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KUNZE
Provider Other First Name:
JOSIE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., BCBA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457826802
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35576 WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOONEVILLE
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
50038-3301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
515-564-9646
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 NW 118TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLIVE
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
50325-8278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
515-402-4130
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2018

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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