Provider Demographics
NPI:1447745583
Name:MONTANO ZELEDON, KIM WENDOLLYN YADIRA
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:WENDOLLYN YADIRA
Last Name:MONTANO ZELEDON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 E 91ST AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-7707
Mailing Address - Country:US
Mailing Address - Phone:720-454-9828
Mailing Address - Fax:
Practice Address - Street 1:12213 PECOS ST STE 200
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-3414
Practice Address - Country:US
Practice Address - Phone:720-459-7493
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-21-52922103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician