Basic Information
| Provider Information | |||||||||
| NPI: | 1306517933 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KIDDOS ABA THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 415 | ||||||||
| Address2: | |||||||||
| City: | KALIDA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458530415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197960306 | ||||||||
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| Practice Location | |||||||||
| Address1: | 415 OTTAWA ROAD | ||||||||
| Address2: | |||||||||
| City: | KALIDA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458534585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4197960306 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2021 | ||||||||
| LastUpdateDate: | 09/23/2021 | ||||||||
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| AuthorizedOfficialLastName: | CLOSSON | ||||||||
| AuthorizedOfficialFirstName: | KRISTEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | COFOUNDER | ||||||||
| AuthorizedOfficialTelephone: | 4197960306 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | 09/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.