MEDICARE: ADELINE LOW

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	:	1225468895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADELINE LOW

Provider Business Mailing Address
First Line	:	1166 S GILBERT RD
Second Line	:	SUITE 106
City	:	GILBERT
State	:	AZ
Zip	:	85296-3460
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1166 S GILBERT RD
Second Line	:	SUITE 106
City	:	GILBERT
State	:	AZ
Zip	:	85296-3460
Country	:	US
Telephone Number	:	303-989-8169
Fax Number	:

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

Provider Enumeration Date	:	11/19/2013
Last Update Date	:	03/29/2022

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