MEDICARE: MR. EDWARD TODD ADDLESON 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	1-05-2115	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770918559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EDWARD TODD ADDLESON BCBA

Provider Business Mailing Address
First Line	:	12331 E CORNELL AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-3323
Country	:	US
Telephone Number	:	720-507-5226
Fax Number	:	720-368-5139

Provider Business Practice Location Address
First Line	:	12331 E CORNELL AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80014-3323
Country	:	US
Telephone Number	:	720-507-5226
Fax Number	:	720-368-5139

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

Provider Enumeration Date	:	09/11/2013
Last Update Date	:	08/30/2021

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