Healthcare Provider Details

I. General information

NPI: 1578091401
Provider Name (Legal Business Name): MATTHEW DICKINSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2017
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5863 NW 72ND ST
KANSAS CITY MO
64151-1483
US

IV. Provider business mailing address

5863 NW 72ND ST
KANSAS CITY MO
64151-1483
US

V. Phone/Fax

Practice location:
  • Phone: 816-984-8282
  • Fax:
Mailing address:
  • Phone: 816-984-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2025033346
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-24-15483
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: