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NPI Code Detail

MEDICARE: LAKEN REEL

MEDICARE: LAKEN REEL
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
1106E00000XAssistant Behavior Analyst
2106S00000XBehavior Technician
3103K00000XBehavior Analyst

General Provider Information

NPI Number : 1790213320
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAKEN REEL
Provider Business Mailing Address
First Line : 5863 NW 72ND ST
Second Line :
City : KANSAS CITY
State : MO
Zip : 64151-1483
Country : US
Telephone Number : 816-984-8280
Fax Number :
Provider Business Practice Location Address
First Line : 610 HUMBOLDT ST
Second Line :
City : MANHATTAN
State : KS
Zip : 66502-6035
Country : US
Telephone Number : 785-706-9352
Fax Number : 785-775-0035
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2017
Last Update Date : 06/13/2024

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Directions to “ LAKEN REEL ” Practice Location

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