MEDICARE: MS. ABIGAIL LEAH KOENIG 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	1-12-11685	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518253590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ABIGAIL LEAH KOENIG BCBA

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

Provider Business Practice Location Address
First Line	:	106 ISABEL CT
Second Line	:
City	:	BUENA VISTA
State	:	CO
Zip	:	81211-9551
Country	:	US
Telephone Number	:	970-422-8339
Fax Number	:	303-957-2251

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

Provider Enumeration Date	:	06/28/2011
Last Update Date	:	08/10/2019

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