Provider Demographics
NPI:1952075889
Name:IKONEN, EVA
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:IKONEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ADAMS ST APT 1406
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-5727
Mailing Address - Country:US
Mailing Address - Phone:720-771-0852
Mailing Address - Fax:
Practice Address - Street 1:1495 YARMOUTH AVE STE B
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-0673
Practice Address - Country:US
Practice Address - Phone:720-771-0852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-178587106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
RBT-21-178587OtherBACB