Healthcare Provider Details

I. General information

NPI: 1114317500
Provider Name (Legal Business Name): MORGAN KEENCE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MORGAN AUFDERHEIDE BCBA

II. Dates (important events)

Enumeration Date: 01/23/2015
Last Update Date: 09/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11872 WESTLINE INDUSTRIAL DR STE 180
SAINT LOUIS MO
63146-3331
US

IV. Provider business mailing address

11 LAKE PARK CT
SAINT PETERS MO
63376-3220
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-7944
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-13-15051
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: