MEDICARE: AUDRA KIPPES RBT

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	106S00000X	Behavior Technician	RBT-24-385728	CO

General Provider Information

NPI Number	:	1811704919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDRA KIPPES RBT

Provider Business Mailing Address
First Line	:	10730 E BETHANY DR STE 355
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-2806
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11674 HURON ST STE 150
Second Line	:
City	:	NORTHGLENN
State	:	CO
Zip	:	80234-4000
Country	:	US
Telephone Number	:	720-634-9502
Fax Number	:

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

Provider Enumeration Date	:	12/12/2024
Last Update Date	:	12/12/2024

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