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General NPI Number Information
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NPI Number | 1073124210
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Entity Type | Individual
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Provider Name | KATELYN RENEE BODEN M.S.
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Gender | Female
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 805 E WASHINGTON ST STE 130
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City | MEDINA
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State | OH
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Zip | 44256-3331
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Country | US
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Telephone | 234-255-8531
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Fax | 330-313-3782
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Provider Business Mailing Address
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Address Line | 7500 SAN FELIPE ST STE 990
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City | HOUSTON
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State | TX
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Zip | 77063-1708
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Country | US
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Telephone | 281-826-3382
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Fax | 425-491-7683
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-19-84783
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License Number State | OH
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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 | 1-24-75349
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License Number State | OH
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