Diana Dorothea Ewoldt, BCABA

Primary specialty

Assistant Behavior AnalystTaxonomy code 106E00000X

License

0-18-9265

Practice address

4905 N Union Blvd Ste 200
Colorado Springs, CO 80918-4058

Phone

(970) 219-9089

Fax

(719) 465-2744

NPI assigned

Dec 17, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1513468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565913600000",
    "number": "1720594526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 STETSON HILLS BLVD # 150",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809233571",
            "telephone_number": "719-209-2102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4905 N UNION BLVD STE 200",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809184058",
            "telephone_number": "970-219-9089",
            "fax_number": "719-465-2744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWOLDT",
        "first_name": "DIANA",
        "middle_name": "DOROTHEA",
        "credential": "BCABA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-17",
        "last_updated": "2019-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": "0-18-9265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assistant Behavior Analyst in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Assistant Behavior Analyst in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2019; 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.