MEDICARE: BONNIE JO KEYS LBA, 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	RBT-17-37196	TX
2	103K00000X	Behavior Analyst	1-1938532	CO

General Provider Information

NPI Number	:	1861986671
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BONNIE JO KEYS LBA, BCBA

Provider Business Mailing Address
First Line	:	5165 BALSAM ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-5144
Country	:	US
Telephone Number	:	903-603-0602
Fax Number	:

Provider Business Practice Location Address
First Line	:	5165 BALSAM ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-5144
Country	:	US
Telephone Number	:	36-030-6029
Fax Number	:

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

Provider Enumeration Date	:	06/15/2018
Last Update Date	:	07/08/2024

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