MEDICARE: BOHDANNA POPOWYCZ KVAM M.ED 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1932583713
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BOHDANNA POPOWYCZ KVAM M.ED BCBA

Provider Business Mailing Address
First Line	:	4025 AUTOMATION WAY
Second Line	:	UNIT B- 2
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3446
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 AUTOMATION WAY
Second Line	:	UNIT B- 2
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-3446
Country	:	US
Telephone Number	:	970-377-9401
Fax Number	:

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

Provider Enumeration Date	:	07/12/2015
Last Update Date	:	07/12/2015

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