Maryellen Koch Jensen, DC, MSED, BCBA, LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

2018037916 Issued in MO

Practice address

606 S Halliburton St
Kirksville, MO 63501-3712

Phone

(660) 341-1105

NPI assigned

Apr 12, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Maryellen C. Koch Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Truman State University

  • Behavior Analyst
  • Kirksville, MO
  • NPI 1578890869
  NPD Authorized official

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1619191574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 WAYNE 375",
            "city": "WILLIAMSVILLE",
            "state": "MO",
            "postal_code": "639678938",
            "telephone_number": "660-341-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "606 S HALLIBURTON ST",
            "city": "KIRKSVILLE",
            "state": "MO",
            "postal_code": "635013712",
            "telephone_number": "660-341-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JENSEN",
        "first_name": "MARYELLEN",
        "middle_name": "KOCH",
        "name_prefix": "Dr.",
        "credential": "DC, MSED, BCBA, LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-12",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NN1001X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Nutrition",
            "state": "MO",
            "license": "2000148952",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "MO",
            "license": "2018037916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYELLEN",
            "last_name": "KOCH",
            "middle_name": "C.",
            "prefix": "DR.",
            "credential": "DC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• James D. Smith, P.C.
• Krysten Jolynn Jarman
• Gretchen L Jedele, RN
• Emily Ann Jennings, MSED, BCBA
• Nathan Jennings
• Julie Mingyeong Jeong
• Marcus Jessen
• Job Connection Services, LLC
• Rebecca L Johnaon, SPEECH AND LANGUAGE
• Jeremy Allen Johnson, DPT

• Behavior Analyst in Kirksville, MO
• Providers in Kirksville, MO by specialty
• Behavior Analyst in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.

Verify at the official NPI Registry.