MEDICARE: MRS. HALEY ROSE KAUFMANN MA, BCBA

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	1-20-40592	IL

General Provider Information

NPI Number	:	1346874674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HALEY ROSE KAUFMANN MA, BCBA

Provider Business Mailing Address
First Line	:	1720 S WHITTIER AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4022
Country	:	US
Telephone Number	:	217-572-2286
Fax Number	:

Provider Business Practice Location Address
First Line	:	1272 S GRAND AVE W
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-3567
Country	:	US
Telephone Number	:	217-572-2286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2020
Last Update Date	:	04/25/2023

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