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General NPI Number Information
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NPI Number | 1861166258
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Entity Type | Individual
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Provider Name | COURTNEY DERONDE BCBA
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Gender | Female
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Dates
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Enumeration Date | 08/09/2021
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 11780 BORMAN DR STE 400
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4135
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Country | US
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Telephone | 314-820-0723
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Fax |
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Provider Business Mailing Address
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Address Line | 186 S PAYNE STEWART DR # 151
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City | BRANSON
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State | MO
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Zip | 65616-2792
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Country | US
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Telephone | 141-769-3068
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Fax |
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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 |
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License Number State | MO
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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 | MO
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