Healthcare Provider Details

I. General information

NPI: 1649860065
Provider Name (Legal Business Name): KENNEDI BOONE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2021
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68583 SCOTT ST
BRIDGEPORT OH
43912
US

IV. Provider business mailing address

1 HALLORAN DRIVE
ST. CLAIRSVILLE OH
43950
US

V. Phone/Fax

Practice location:
  • Phone: 740-298-7078
  • Fax:
Mailing address:
  • Phone: 740-269-5743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-21-152267
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72827
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: