| Independence Aba | |
|
5 E Bijou St Ste 116 Colorado Springs CO 80903-1301 | |
| (714) 403-8186 | |
| (855) 719-3133 |
| Full Name | Independence Aba |
|---|---|
| Speciality | Behavior Analyst |
| Location | 5 E Bijou St Ste 116, Colorado Springs, Colorado |
| Authorized Official Name and Position | Ronni Clark (OWNER) |
| Authorized Official Contact | 7144038186 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Independence Aba 5 E Bijou St Ste 116 Colorado Springs CO 80903-1301 Ph: (714) 403-8186 | Independence Aba 5 E Bijou St Ste 116 Colorado Springs CO 80903-1301 Ph: (714) 403-8186 |
| NPI Number | 1629547732 |
|---|---|
| Provider Enumeration Date | 11/19/2018 |
| Last Update Date | 08/30/2021 |
| Certification Date | 08/30/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629547732 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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