Kaitlyn Bradshaw, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-20-45677 Issued in LA

Practice address

745 10TH St Ste C
Rock Valley, IA 51247-1511

Phone

(712) 454-3484

NPI assigned

Aug 20, 2018

Last updated

Jul 12, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wardell Interest, Inc.

  • Speech-Language Pathologist
  • Shreveport, LA
  • NPI 1134477813

  Multi-Specialty

  NPD (past)
• Wardell Interests, Inc

  dba Little Works In Progress

  • Speech-Language Pathologist
  • Shreveport, LA
  • NPI 1134266083

  Multi-Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1534723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626048000000",
    "number": "1093295032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 W RUSSELL ST",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571041322",
            "telephone_number": "605-271-2690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "745 10TH ST STE C",
            "city": "ROCK VALLEY",
            "state": "IA",
            "postal_code": "512471511",
            "telephone_number": "712-454-3484"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2522 E 70th St",
            "address_purpose": "LOCATION",
            "city": "Shreveport",
            "state": "LA",
            "postal_code": "711054002",
            "country_code": "US",
            "telephone_number": "318-795-3388",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADSHAW",
        "first_name": "KAITLYN",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-08-20",
        "last_updated": "2021-07-12",
        "certification_date": "2021-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "LA",
            "license": "1-20-45677",
            "primary": true
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "LA",
            "license": "RBT-18-57026",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2455559",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lejeana Marie Anliker, MS MHC
• Sarah Connors Beucher, MD
• Austin John Blankespoor, DDS
• Jordyn Grace Broek
• Jacob Paul Brosamle, D.C.
• Mary Elizabeth Brown, FNP-C
• Chirosport Rock Valley, PC
• City of Rock Valley

• Behavior Analyst in Rock Valley, IA
• Providers in Rock Valley, IA by specialty
• Behavior Analyst in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.