Healthcare Provider Details

I. General information

NPI: 1295487544
Provider Name (Legal Business Name): EMMA GRACE DODSON MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

802 E MAIN ST
WATERTOWN TN
37184-1412
US

IV. Provider business mailing address

802 E MAIN ST
WATERTOWN TN
37184-1412
US

V. Phone/Fax

Practice location:
  • Phone: 314-775-5224
  • Fax:
Mailing address:
  • Phone: 314-775-5224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90781
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: