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General NPI Number Information
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NPI Number | 1063971166
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Entity Type | Organization
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Legal Business Name | DEVELOPMENTAL WELLNESS
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Dates
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Enumeration Date | 03/18/2019
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 910 WASHINGTON ST
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City | PELLA
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State | IA
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Zip | 50219-1504
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Country | US
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Telephone | 515-664-3244
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Fax | 844-519-7713
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Provider Business Mailing Address
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Address Line | 4912 WALKER CIR
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City | JOHNSTON
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State | IA
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Zip | 50131-2535
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Country | US
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Telephone | 515-664-3244
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Fax | 844-519-7713
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Authorized Official
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Title or Position | OWNER/CHIEF CLINICAL OFFICER
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Name | KYLE CERVONE
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Credential | BCBA
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Telephone | 515-664-3422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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