MEDICARE: MRS. COLLEEN KADIYALA BCABA

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	0-15-6626	TX

General Provider Information

NPI Number	:	1821458621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COLLEEN KADIYALA BCABA

Provider Business Mailing Address
First Line	:	1939 S QUEBEC WAY
Second Line	:	APT E508
City	:	DENVER
State	:	CO
Zip	:	80231-3335
Country	:	US
Telephone Number	:	414-581-3358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1939 S QUEBEC WAY
Second Line	:	APT E508
City	:	DENVER
State	:	CO
Zip	:	80231-3335
Country	:	US
Telephone Number	:	414-581-3358
Fax Number	:

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

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	03/07/2016

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