Healthcare Provider Details

I. General information

NPI: 1689066565
Provider Name (Legal Business Name): KRISTIN ARLENE JENNY KASCHUB MS BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KRISTIN ARLENE SWANSON MS BCBA

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 PERRY ST
NEWNAN GA
30263-1918
US

IV. Provider business mailing address

13652 DERBY LINE RD
GENOA IL
60135-8028
US

V. Phone/Fax

Practice location:
  • Phone: 847-754-1718
  • Fax:
Mailing address:
  • Phone: 847-754-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-17389
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number1-14-17389
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: