Healthcare Provider Details

I. General information

NPI: 1811704919
Provider Name (Legal Business Name): AUDRA KIPPES BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E 104TH AVE STE 115
THORNTON CO
80233-4402
US

IV. Provider business mailing address

3095 S PARKER RD FL 2
AURORA CO
80014-2924
US

V. Phone/Fax

Practice location:
  • Phone: 720-634-9502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2852526
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: