Provider Demographics
NPI:1881284834
Name:KNESE, ZACHARY (BCBA)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:KNESE
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4451 LITTLE CHIEF DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-6639
Mailing Address - Country:US
Mailing Address - Phone:314-482-3025
Mailing Address - Fax:
Practice Address - Street 1:7522 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2104
Practice Address - Country:US
Practice Address - Phone:314-532-0544
Practice Address - Fax:573-874-1723
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-24
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RBT-21-157472106S00000X
390200000X
MO2022044865103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program