Provider Demographics
NPI:1841571817
Name:VESEL, SHAWN (MS, BCBA)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:VESEL
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2881 FULLER RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3618
Mailing Address - Country:US
Mailing Address - Phone:719-464-7954
Mailing Address - Fax:
Practice Address - Street 1:2881 FULLER RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3618
Practice Address - Country:US
Practice Address - Phone:719-464-7954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-11-8658103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst