MEDICARE: TATE KNUDSEN 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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	2025020405	MO

General Provider Information

NPI Number	:	1265071815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TATE KNUDSEN BCBA

Provider Business Mailing Address
First Line	:	7216 PENNSYLVANIA AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64114-1319
Country	:	US
Telephone Number	:	913-213-3146
Fax Number	:

Provider Business Practice Location Address
First Line	:	2850 NE KENDALLWOOD PKWY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64119-2173
Country	:	US
Telephone Number	:	816-226-7540
Fax Number	:

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

Provider Enumeration Date	:	12/30/2019
Last Update Date	:	04/17/2026

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Directions to “ TATE KNUDSEN BCBA” Practice Location

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