Healthcare Provider Details

I. General information

NPI: 1396514808
Provider Name (Legal Business Name): ANNALISA DEITZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

234 N. MAIN STREET
GUNNISON CO
81230-2438
US

IV. Provider business mailing address

10650 E BETHANY DRIVE
AURORA CO
80014
US

V. Phone/Fax

Practice location:
  • Phone: 720-584-8055
  • Fax: 303-958-2251
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72635
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: