Healthcare Provider Details

I. General information

NPI: 1285100891
Provider Name (Legal Business Name): CODY RABIDEAU BCBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2018
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 N UNION BLVD
COLORADO SPRINGS CO
80909-2871
US

IV. Provider business mailing address

1425 N UNION BLVD
COLORADO SPRINGS CO
80909-2871
US

V. Phone/Fax

Practice location:
  • Phone: 719-922-7906
  • Fax: 720-367-5263
Mailing address:
  • Phone: 719-922-7906
  • Fax: 720-367-5263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59298
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: