Active NPI
Kennedy Ibarra, BCBA
- Behavior Analyst
- Maumee, OH
National Provider Identifier
1558020982
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- BACB460914
- Practice address
- 3521 Briarfield Blvd Ste C
Maumee, OH 43537-9385 - Phone
- (419) 794-7259
- NPI assigned
- Dec 13, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | BACB460914 | OH | Primary |
Addresses
Primary practice location
3521 Briarfield Blvd Ste C
Maumee, OH 43537-9385
Mailing address
3521 Briarfield Blvd Ste C
Maumee, OH 43537-9385
Phone (419) 794-7259
Other names 1
- Kennedy Wade
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BACB460914 | OH | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1714694400000",
"number": "1558020982",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3521 BRIARFIELD BLVD STE C",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435379385",
"telephone_number": "419-794-7259"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3521 BRIARFIELD BLVD STE C",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435379385",
"telephone_number": "419-794-7259"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IBARRA",
"first_name": "KENNEDY",
"credential": "BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-12-13",
"last_updated": "2024-05-03",
"certification_date": "2024-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "OH",
"license": "BACB460914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KENNEDY",
"last_name": "WADE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Maumee, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.