Healthcare Provider Details

I. General information

NPI: 1366068819
Provider Name (Legal Business Name): KATHRYN DRYE MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 10/03/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 TUTOR LN STE 107
EVANSVILLE IN
47715-7295
US

IV. Provider business mailing address

3130 GREEN RIVER DR APT 1231
EVANSVILLE IN
47715-1492
US

V. Phone/Fax

Practice location:
  • Phone: 812-602-1038
  • Fax: 812-602-1048
Mailing address:
  • Phone: 812-499-5923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-42052
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: