Individual
ETHAN DANIEL KINGERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
630 SOUTHPOINTE CT STE 105, COLORADO SPRINGS, CO 80906-3800
(179) 538-5600
Mailing address
PO BOX 504, SIMLA, CO 80835-0504
(719) 287-9801
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
02/14/2018
Last updated
02/14/2018
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