Healthcare Provider Details

I. General information

NPI: 1053151712
Provider Name (Legal Business Name): ANGELA D ZOLMAN M.S. BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2024
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 BERRY RD
BONNE TERRE MO
63628-3580
US

IV. Provider business mailing address

209 N FIRMAN ST
PARK HILLS MO
63601-3703
US

V. Phone/Fax

Practice location:
  • Phone: 573-431-3300
  • Fax: 573-534-0182
Mailing address:
  • Phone: 573-330-0295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2024005681
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: