MEDICARE: ALEXIS KNIGHT M.A. ED. 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	103K00000X	Behavior Analyst	1-18-31606	CO

General Provider Information

NPI Number	:	1619447042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS KNIGHT M.A. ED. BCBA

Provider Business Mailing Address
First Line	:	10878 HIGHWAY 13
Second Line	:
City	:	RIFLE
State	:	CO
Zip	:	81650-9526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 E 3RD ST
Second Line	:
City	:	RIFLE
State	:	CO
Zip	:	81650-2346
Country	:	US
Telephone Number	:	970-781-9041
Fax Number	:

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

Provider Enumeration Date	:	11/28/2018
Last Update Date	:	10/23/2024

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