Healthcare Provider Details

I. General information

NPI: 1144918129
Provider Name (Legal Business Name): KAELEN KOENIG BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: N/A HARPER

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 FOREST DR STE 160
ANNAPOLIS MD
21401-4211
US

IV. Provider business mailing address

7120 SAMUEL MORSE DR STE 150
COLUMBIA MD
21046-3420
US

V. Phone/Fax

Practice location:
  • Phone: 855-935-3691
  • Fax:
Mailing address:
  • Phone: 855-935-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88411
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: