MEDICARE: KELLEY ANDERSON MS, 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
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1114550803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLEY ANDERSON MS, BCBA

Provider Business Mailing Address
First Line	:	2906 GINNALA DR
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-2700
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	805 DESERT FLOWER BLVD
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81001-1146
Country	:	US
Telephone Number	:	719-501-4416
Fax Number	:

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

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	12/12/2025

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