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NPI Code Detail

MEDICARE: KATELYND DENISE VASALLO BCBA

MEDICARE: KATELYND DENISE VASALLO 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 Analyst5709TX

General Provider Information

NPI Number : 1780384586
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYND DENISE VASALLO BCBA
Provider Business Mailing Address
First Line : 7108 SOUTH KANNER HWY
Second Line :
City : STUART
State : FL
Zip : 34997-7462
Country : US
Telephone Number : 903-330-0274
Fax Number :
Provider Business Practice Location Address
First Line : 1614 AVENUE M
Second Line : SUITE 42
City : LUBBOCK
State : TX
Zip : 79401-4952
Country : US
Telephone Number : 903-330-0274
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2023
Last Update Date : 06/24/2026

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Directions to “ KATELYND DENISE VASALLO BCBA” Practice Location

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