MEDICARE: ILEA MARIE ADAMS BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1114429222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILEA MARIE ADAMS BCBA

Provider Business Mailing Address
First Line	:	2001 N SCOTTSDALE RD APT 2016
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-0122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 S COUNTRY CLUB DR STE 38
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85210-6886
Country	:	US
Telephone Number	:	510-268-8130
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/05/2018
Last Update Date	:	05/15/2023

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