Healthcare Provider Details

I. General information

NPI: 1861900557
Provider Name (Legal Business Name): LIDIA KAMIONKA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2018
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12015 E 46TH AVE
DENVER CO
80239-3116
US

IV. Provider business mailing address

12015 E 46TH AVE
DENVER CO
80239-3116
US

V. Phone/Fax

Practice location:
  • Phone: 172-070-6339
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49447
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: