Healthcare Provider Details

I. General information

NPI: 1659881035
Provider Name (Legal Business Name): KP ENTERPRISES IOWA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 10/11/2017
Certification Date:
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

32673 663RD AVE
MAXWELL IA
50161-8621
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: KRISTIN MARIE HANSON
Title or Position: PRESIDENT
Credential: BCBA
Phone: 515-291-3905