Healthcare Provider Details

I. General information

NPI: 1003316233
Provider Name (Legal Business Name): KRISTY LEIGH KOJCSICH BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2018
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2890 S NEWCOMBE WAY
LAKEWOOD CO
80227-2626
US

IV. Provider business mailing address

2890 S NEWCOMBE WAY
LAKEWOOD CO
80227-2626
US

V. Phone/Fax

Practice location:
  • Phone: 252-259-4340
  • Fax:
Mailing address:
  • Phone: 252-259-4340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-16034
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: