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NPI Code Detail

MEDICARE: HEATHER MARIE FELSKE MS ABA, BCBA, LBA

MEDICARE: HEATHER MARIE FELSKE MS ABA, BCBA, LBA
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
1103K00000XBehavior Analyst2020029509MO

General Provider Information

NPI Number : 1437789914
Entity Type Code : Individual
Provider Name (Legal Business Name) : HEATHER MARIE FELSKE MS ABA, BCBA, LBA
Provider Business Mailing Address
First Line : 4453 S ROANOKE AVE
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65810-1821
Country : US
Telephone Number : 417-844-1142
Fax Number :
Provider Business Practice Location Address
First Line : 116 W SHERMAN WAY STE 1
Second Line :
City : NIXA
State : MO
Zip : 65714-9022
Country : US
Telephone Number : 417-298-0984
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2020
Last Update Date : 06/25/2021

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