Healthcare Provider Details

I. General information

NPI: 1346123015
Provider Name (Legal Business Name): ABBIE CORONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 DOCTORS PARK
CAPE GIRARDEAU MO
63703-4928
US

IV. Provider business mailing address

14 DOCTORS PARK
CAPE GIRARDEAU MO
63703-4928
US

V. Phone/Fax

Practice location:
  • Phone: 573-339-9300
  • Fax:
Mailing address:
  • Phone: 573-339-9300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2025032031
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: