MEDICARE: BY YOUR SIDE COLORADO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1013524297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BY YOUR SIDE COLORADO, LLC

Provider Business Mailing Address
First Line	:	8201 CASS AVE
Second Line	:
City	:	DARIEN
State	:	IL
Zip	:	60561-5314
Country	:	US
Telephone Number	:	630-590-5571
Fax Number	:

Provider Business Practice Location Address
First Line	:	8415 EXPLORER DR STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-1034
Country	:	US
Telephone Number	:	630-590-5571
Fax Number	:	630-326-7175

Authorized Official
Title or Position	:	SR MANAGER-BILLING
Name	:	KATHY KOZICKI
Credential	:
Telephone Number	:	630-590-5571

Provider Enumeration Date	:	09/30/2020
Last Update Date	:	02/04/2021

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