Healthcare Provider Details

I. General information

NPI: 1134764772
Provider Name (Legal Business Name): BETHANY S HOLLAND MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 07/23/2023
Certification Date: 07/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 3RD ST SE
CRESCO IA
52136-2030
US

IV. Provider business mailing address

540 3RD ST SE
CRESCO IA
52136-2030
US

V. Phone/Fax

Practice location:
  • Phone: 563-203-2327
  • Fax:
Mailing address:
  • Phone: 563-203-2327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52419
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: