Healthcare Provider Details

I. General information

NPI: 1376837104
Provider Name (Legal Business Name): AUTUMN NICOLE MCKEEL PH. D., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 S ANKENY BLVD STE 111
ANKENY IA
50023-9417
US

IV. Provider business mailing address

2825 S ANKENY BLVD STE 111
ANKENY IA
50023-9417
US

V. Phone/Fax

Practice location:
  • Phone: 515-598-7200
  • Fax: 515-598-7323
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: