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NPI Code Detail

MEDICARE: MADELINE SUZANNE LOCKE BCBA, LBA

MEDICARE: MADELINE SUZANNE LOCKE 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 Analyst2018023465MO

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 : 1477019891
Entity Type Code : Individual
Provider Name (Legal Business Name) : MADELINE SUZANNE LOCKE BCBA, LBA
Provider Business Mailing Address
First Line : 11432 TESSON FERRY RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-6925
Country : US
Telephone Number : 217-525-8332
Fax Number :
Provider Business Practice Location Address
First Line : 11432 TESSON FERRY RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63123-6925
Country : US
Telephone Number : 217-525-8332
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/11/2019
Last Update Date : 02/03/2023

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Directions to “ MADELINE SUZANNE LOCKE BCBA, LBA” Practice Location

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