Provider Demographics
NPI:1235498551
Name:SHIVELY, DAWNITA MICHELL (BCBA)
Entity Type:Individual
Prefix:
First Name:DAWNITA
Middle Name:MICHELL
Last Name:SHIVELY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:DAWNITA
Other - Middle Name:MICHELL
Other - Last Name:STREITENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:8907 MAPLECREEK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-4839
Mailing Address - Country:US
Mailing Address - Phone:502-294-6091
Mailing Address - Fax:
Practice Address - Street 1:663 N DIXIE BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1376
Practice Address - Country:US
Practice Address - Phone:614-593-0382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-07
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-11-9467103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst