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NPI Code Detail

MEDICARE: MRS. JULIE ANNE DAUTERIVE BCBA

MEDICARE: MRS. JULIE ANNE DAUTERIVE 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
1106S00000XBehavior TechnicianRBT-17-41541IA
2103K00000XBehavior Analyst1-19-35016

Other Identifiers

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

General Provider Information

NPI Number : 1518472430
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JULIE ANNE DAUTERIVE BCBA
Provider Business Mailing Address
First Line : 13300 HICKMAN RD STE 110
Second Line :
City : CLIVE
State : IA
Zip : 50325-8616
Country : US
Telephone Number : 515-987-8835
Fax Number :
Provider Business Practice Location Address
First Line : 13300 HICKMAN RD STE 110
Second Line :
City : CLIVE
State : IA
Zip : 50325-8616
Country : US
Telephone Number : 515-987-8835
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2017
Last Update Date : 08/06/2021

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