Healthcare Provider Details

I. General information

NPI: 1154230217
Provider Name (Legal Business Name): NYAKAISIKI LILLIAN WIEDERHOLT RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 E EVANS AVE
DENVER CO
80222-5406
US

IV. Provider business mailing address

1301 S RARITAN ST
DENVER CO
80223-3329
US

V. Phone/Fax

Practice location:
  • Phone: 720-505-6293
  • Fax:
Mailing address:
  • Phone: 720-505-6293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1265116
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: