=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518506419
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDZ COMPANION INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2019
-----------------------------------------------------
Last Update Date | 12/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 N FEDERAL HWY SUITE 200 OFFICE 57
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-922-9178
-----------------------------------------------------
Fax | 561-922-9178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 N FEDERAL HWY SUITE 200 OFFICE 57
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33432
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-922-9178
-----------------------------------------------------
Fax | 561-922-9178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | YOLANDE STEPHENSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-923-0695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103K00000X
-----------------------------------------------------
Taxonomy Name | Behavior Analyst
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------