Provider Demographics
NPI:1033653498
Name:SIMON, KENON
Entity Type:Individual
Prefix:
First Name:KENON
Middle Name:
Last Name:SIMON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 N WALNUT RD
Mailing Address - Street 2:APT 221
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-6409
Mailing Address - Country:US
Mailing Address - Phone:702-779-9812
Mailing Address - Fax:
Practice Address - Street 1:1950 N WALNUT RD
Practice Address - Street 2:APT 221
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89115-6409
Practice Address - Country:US
Practice Address - Phone:702-779-9812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-05
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst