Provider Demographics
NPI:1669850400
Name:MONTANDON, ABIGAIL (BCBA)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:
Last Name:MONTANDON
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 1:8109 NW ROBERTS RD
Mailing Address - Street 2:
Mailing Address - City:WEATHERBY LAKE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-4816
Mailing Address - Country:US
Mailing Address - Phone:619-456-1814
Mailing Address - Fax:
Practice Address - Street 1:21727 HITCHING POST RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-2684
Practice Address - Country:US
Practice Address - Phone:801-836-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11417220103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst