MEDICARE: KATELYN ASHLEY MCGEE MA, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-15-20750	OTHER	MI	BACB

General Provider Information

NPI Number	:	1164888343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN ASHLEY MCGEE MA, BCBA

Provider Business Mailing Address
First Line	:	406 FAIRWOOD RD
Second Line	:
City	:	PINCKNEY
State	:	MI
Zip	:	48169-9026
Country	:	US
Telephone Number	:	734-730-4941
Fax Number	:	269-459-1123

Provider Business Practice Location Address
First Line	:	526 W CENTRE AVE
Second Line	:
City	:	PORTAGE
State	:	MI
Zip	:	49024-5306
Country	:	US
Telephone Number	:	269-321-9556
Fax Number	:

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

Provider Enumeration Date	:	01/04/2016
Last Update Date	:	01/04/2016

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