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NPI Code Detail

MEDICARE: DESTINEE COLVIN RBT

MEDICARE: DESTINEE COLVIN RBT
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1265363634
Entity Type Code : Individual
Provider Name (Legal Business Name) : DESTINEE COLVIN RBT
Provider Business Mailing Address
First Line : 4721 S CLIFF AVE STE 103
Second Line :
City : INDEPENDENCE
State : MO
Zip : 64055-6969
Country : US
Telephone Number : 816-608-1956
Fax Number : 800-687-5070
Provider Business Practice Location Address
First Line : 12100 SAINT CHARLES ROCK RD UNIT 5
Second Line :
City : BRIDGETON
State : MO
Zip : 63044-2601
Country : US
Telephone Number : 636-398-2500
Fax Number : 800-687-5070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2026
Last Update Date : 05/26/2026

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Directions to “ DESTINEE COLVIN RBT” Practice Location

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