Healthcare Provider Details

I. General information

NPI: 1588813372
Provider Name (Legal Business Name): OZGUL KADRIYE HOLMGREN M. ED, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11133 E MESQUITE DR
SCOTTSDALE AZ
85262-3530
US

IV. Provider business mailing address

11133 E MESQUITE DR
SCOTTSDALE AZ
85262-3530
US

V. Phone/Fax

Practice location:
  • Phone: 631-804-4268
  • Fax:
Mailing address:
  • Phone: 631-804-4268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-30528
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-000739
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: