Healthcare Provider Details

I. General information

NPI: 1477942241
Provider Name (Legal Business Name): NICOLE DIANE MEANY KWIATKOWSKI M.ED., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2015
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 HOWE AVE STE 207
SACRAMENTO CA
95825-3364
US

IV. Provider business mailing address

1328 BLUE OAKS BLVD STE 180
ROSEVILLE CA
95678-7037
US

V. Phone/Fax

Practice location:
  • Phone: 916-676-0488
  • Fax: 916-993-9223
Mailing address:
  • Phone: 916-676-0488
  • Fax: 916-771-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16080
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: