Healthcare Provider Details

I. General information

NPI: 1669912101
Provider Name (Legal Business Name): BRANDIE ANN KRETZSCHMAR BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2017
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 GARDEN OF THE GODS ROAD SUITE 150
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

1355 GARDEN OF THE GODS ROAD SUITE 150
COLORADO SPRINGS CO
80907
US

V. Phone/Fax

Practice location:
  • Phone: 719-212-6535
  • Fax:
Mailing address:
  • Phone: 719-212-6535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-30034
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: