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NPI Code Detail

MEDICARE: DR. COURTNEY SOWLE SHELLEY BCBA

MEDICARE: DR. COURTNEY SOWLE SHELLEY 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 Analyst1-21-52637
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1912487141
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. COURTNEY SOWLE SHELLEY BCBA
Provider Business Mailing Address
First Line : 145 LONG ST
Second Line :
City : MANKATO
State : MN
Zip : 56001-5254
Country : US
Telephone Number : 563-503-9934
Fax Number :
Provider Business Practice Location Address
First Line : 1701 ADAMS ST
Second Line :
City : MANKATO
State : MN
Zip : 56001-4895
Country : US
Telephone Number : 507-565-0150
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2018
Last Update Date : 12/08/2025

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