Healthcare Provider Details

I. General information

NPI: 1376044016
Provider Name (Legal Business Name): KATHERINE ANN QUICK MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2018
Last Update Date: 08/26/2021
Certification Date: 07/20/2021
Deactivation Date: 07/08/2021
Reactivation Date: 07/20/2021

III. Provider practice location address

2375 E CAMELBACK RD STE 600
PHOENIX AZ
85016-3493
US

IV. Provider business mailing address

4918 LOWELL BLVD
DENVER CO
80221-1028
US

V. Phone/Fax

Practice location:
  • Phone: 602-584-9860
  • Fax:
Mailing address:
  • Phone: 630-740-1352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: