Healthcare Provider Details

I. General information

NPI: 1063971166
Provider Name (Legal Business Name): DEVELOPMENTAL WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 WASHINGTON ST
PELLA IA
50219-1504
US

IV. Provider business mailing address

4912 WALKER CIR
JOHNSTON IA
50131-2535
US

V. Phone/Fax

Practice location:
  • Phone: 515-664-3244
  • Fax: 844-519-7713
Mailing address:
  • Phone: 515-664-3244
  • Fax: 844-519-7713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KYLE CERVONE
Title or Position: OWNER/CHIEF CLINICAL OFFICER
Credential: BCBA
Phone: 515-664-3422