Healthcare Provider Details

I. General information

NPI: 1750856738
Provider Name (Legal Business Name): KIMBERLY SHIGO MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1252 11TH ST
HAMMONTON NJ
08037-2858
US

IV. Provider business mailing address

1252 11TH ST
HAMMONTON NJ
08037-2858
US

V. Phone/Fax

Practice location:
  • Phone: 609-481-2795
  • Fax:
Mailing address:
  • Phone: 609-970-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41008
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: