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NPI Code Detail

MEDICARE: DANIELLE BODEN BCBA

MEDICARE: DANIELLE BODEN 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1588338057
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE BODEN BCBA
Provider Business Mailing Address
First Line : 215 RED COACH DR
Second Line :
City : MISHAWAKA
State : IN
Zip : 46545-8307
Country : US
Telephone Number : 574-387-4313
Fax Number : 574-204-2868
Provider Business Practice Location Address
First Line : 4625 W KL AVE
Second Line :
City : KALAMAZOO
State : MI
Zip : 49006-6209
Country : US
Telephone Number : 269-359-0689
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2021
Last Update Date : 03/29/2023

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Directions to “ DANIELLE BODEN BCBA” Practice Location

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