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Individual

IVAN IP

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1001 FORT CROOK RD N STE 204, BELLEVUE, NE 68005-4226
(402) 432-0377
Mailing address
8300 JEFFERSON ST NE STE B, ALBUQUERQUE, NM 87113-1734

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0816
NE
106S00000X
Behavior Technician
Primary

Other

Enumeration date
04/28/2022
Last updated
03/10/2026
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