MEDICARE: KERRY ANN CONDE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1-10-7002	OTHER	FL	BEHAVIOR ANALYST CERTIFICATION BOARD

General Provider Information

NPI Number	:	1215367933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY ANN CONDE MS, BCBA

Provider Business Mailing Address
First Line	:	7860 E BERRY PL STE 140
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2326
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7860 E BERRY PL STE 140
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-2326
Country	:	US
Telephone Number	:	720-470-0578
Fax Number	:

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

Provider Enumeration Date	:	11/15/2013
Last Update Date	:	11/15/2013

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