Provider Demographics
NPI:1013270388
Name:KOEHLER, SHANNON (BCBA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:KOEHLER
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 1:14 S MAIN ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4172
Mailing Address - Country:US
Mailing Address - Phone:605-225-1010
Mailing Address - Fax:605-225-1017
Practice Address - Street 1:14 S MAIN ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4172
Practice Address - Country:US
Practice Address - Phone:605-225-1010
Practice Address - Fax:605-225-1017
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-12730103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst