Provider Demographics
NPI:1821458621
Name:KADIYALA, COLLEEN (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:
Last Name:KADIYALA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1939 S QUEBEC WAY
Mailing Address - Street 2:APT E508
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-3335
Mailing Address - Country:US
Mailing Address - Phone:414-581-3358
Mailing Address - Fax:
Practice Address - Street 1:1939 S QUEBEC WAY
Practice Address - Street 2:APT E508
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-3335
Practice Address - Country:US
Practice Address - Phone:414-581-3358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0-15-6626103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst