Healthcare Provider Details

I. General information

NPI: 1275021222
Provider Name (Legal Business Name): LENA KALTENBRUNNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MUSEUM RD
CONWAY AR
72032-4739
US

IV. Provider business mailing address

1301 MUSEUM RD
CONWAY AR
72032-4739
US

V. Phone/Fax

Practice location:
  • Phone: 501-358-6535
  • Fax:
Mailing address:
  • Phone: 501-358-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: