Provider Demographics
NPI:1518253590
Name:KOENIG, ABIGAIL LEAH (BCBA)
Entity Type:Individual
Prefix:MS
First Name:ABIGAIL
Middle Name:LEAH
Last Name:KOENIG
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MRS
Other - First Name:ABIGAIL
Other - Middle Name:LEAH
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:10650 E BETHANY DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2653
Mailing Address - Country:US
Mailing Address - Phone:970-433-8339
Mailing Address - Fax:303-957-2251
Practice Address - Street 1:106 ISABEL CT
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-9551
Practice Address - Country:US
Practice Address - Phone:970-422-8339
Practice Address - Fax:303-957-2251
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-12-11685103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO21020388Medicaid