Healthcare Provider Details

I. General information

NPI: 1982949616
Provider Name (Legal Business Name): ERIN KATHLEEN LANDGRAF BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 DONALD ST
SONOMA CA
95476-4610
US

IV. Provider business mailing address

7108 S KANNER HWY
STUART FL
34997-7462
US

V. Phone/Fax

Practice location:
  • Phone: 818-522-1440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-12-12686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: