Provider Demographics
NPI:1407568207
Name:WAHLQUIST, ROSEMARY (BCBA)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:WAHLQUIST
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4655 W 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-1111
Mailing Address - Country:US
Mailing Address - Phone:608-843-9515
Mailing Address - Fax:
Practice Address - Street 1:1961 DAYTON ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-2032
Practice Address - Country:US
Practice Address - Phone:608-843-9515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-22-63076103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst