Healthcare Provider Details

I. General information

NPI: 1699473520
Provider Name (Legal Business Name): COLORADO SPRINGS ABA THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 02/20/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7900 E UNION AVE STE 1100
DENVER CO
80237-2746
US

IV. Provider business mailing address

330 E COSTILLA ST # 1024
COLORADO SPRINGS CO
80903-2106
US

V. Phone/Fax

Practice location:
  • Phone: 719-602-2629
  • Fax:
Mailing address:
  • Phone: 719-602-2629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VLADIMIR KOGAN
Title or Position: CEO
Credential:
Phone: 646-598-7765