MEDICARE: WHITNEY RICHEAUX-MCDADE MSW; 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	1-23-64241	CO

General Provider Information

NPI Number	:	1477069276
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WHITNEY RICHEAUX-MCDADE MSW; BCBA

Provider Business Mailing Address
First Line	:	2812 MERRY LN
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2535
Country	:	US
Telephone Number	:	719-271-3364
Fax Number	:

Provider Business Practice Location Address
First Line	:	1935 DOMINION WAY STE 104
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-1464
Country	:	US
Telephone Number	:	719-344-8756
Fax Number	:

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

Provider Enumeration Date	:	12/17/2017
Last Update Date	:	02/27/2023

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