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General NPI Number Information
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NPI Number | 1669054912
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Entity Type | Organization
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Legal Business Name | BEHAVIOR INDEPENDENCE LLC
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 43636 KALIFORNSKY BEACH RD
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City | SOLDOTNA
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State | AK
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Zip | 99669-8264
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Country | US
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Telephone | 907-931-5548
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Fax | 248-292-8472
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Provider Business Mailing Address
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Address Line | PO BOX 771324
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City | EAGLE RIVER
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State | AK
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Zip | 99577-1324
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Country | US
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Telephone | 907-931-5548
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Fax |
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Authorized Official
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Title or Position | CO-OWNER/ COO
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Name | KARI N BLACKBURN
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Credential |
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Telephone | 907-931-5548
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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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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