Provider Demographics
NPI:1740788835
Name:NIKKEL, DYLAN (RBT)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:NIKKEL
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14844 W 107TH ST
Mailing Address - Street 2:
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4002
Mailing Address - Country:US
Mailing Address - Phone:720-319-7614
Mailing Address - Fax:720-319-7614
Practice Address - Street 1:14844 W 107TH ST
Practice Address - Street 2:
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4002
Practice Address - Country:US
Practice Address - Phone:720-319-7614
Practice Address - Fax:720-319-7614
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ16-22492106S00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician