Provider Demographics
NPI:1518472430
Name:DAUTERIVE, JULIE ANNE (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:ANNE
Last Name:DAUTERIVE
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:MISS
Other - First Name:JULIE
Other - Middle Name:ANNE
Other - Last Name:CANNATELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13300 HICKMAN RD STE 110
Mailing Address - Street 2:
Mailing Address - City:CLIVE
Mailing Address - State:IA
Mailing Address - Zip Code:50325-8616
Mailing Address - Country:US
Mailing Address - Phone:515-987-8835
Mailing Address - Fax:
Practice Address - Street 1:13300 HICKMAN RD STE 110
Practice Address - Street 2:
Practice Address - City:CLIVE
Practice Address - State:IA
Practice Address - Zip Code:50325-8616
Practice Address - Country:US
Practice Address - Phone:515-987-8835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IARBT-17-41541106S00000X
1-19-35016103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician