Healthcare Provider Details

I. General information

NPI: 1316446958
Provider Name (Legal Business Name): KILEY JOHNSON M.A., BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2018
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 SE DELAWARE AVE STE O
ANKENY IA
50021-4011
US

IV. Provider business mailing address

1555 SE DELAWARE AVE STE O
ANKENY IA
50021-4011
US

V. Phone/Fax

Practice location:
  • Phone: 515-261-2402
  • Fax:
Mailing address:
  • Phone: 515-261-2402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-48268
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-18-49382
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: