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NPI Code Detail

MEDICARE: KRYSTAL BROOKE ROWE BCBA

MEDICARE: KRYSTAL BROOKE ROWE 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
1101YM0800XMental Health Counselor
2103K00000XBehavior AnalystBACB520256MI
3247200000XOther Technician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336794932
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTAL BROOKE ROWE BCBA
Provider Business Mailing Address
First Line : 7108 S KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number : 855-832-6727
Fax Number :
Provider Business Practice Location Address
First Line : 600 3 MILE RD NW
Second Line : SUITE 200
City : GRAND RAPIDS
State : MI
Zip : 49544-1691
Country : US
Telephone Number : 616-469-3870
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2019
Last Update Date : 03/10/2026

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