MEDICARE: COURTNEY DERONDE 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	106S00000X	Behavior Technician		MO
2	103K00000X	Behavior Analyst		MO

General Provider Information

NPI Number	:	1861166258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY DERONDE BCBA

Provider Business Mailing Address
First Line	:	186 S PAYNE STEWART DR # 151
Second Line	:
City	:	BRANSON
State	:	MO
Zip	:	65616-2792
Country	:	US
Telephone Number	:	141-769-3068
Fax Number	:

Provider Business Practice Location Address
First Line	:	11780 BORMAN DR STE 400
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4135
Country	:	US
Telephone Number	:	314-820-0723
Fax Number	:

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

Provider Enumeration Date	:	08/09/2021
Last Update Date	:	09/25/2024

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Directions to “ COURTNEY DERONDE BCBA” Practice Location

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