Healthcare Provider Details

I. General information

NPI: 1003628694
Provider Name (Legal Business Name): KIRSTEN YAMASAKI BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16414 SOUTHPARK DR
WESTFIELD IN
46074-8396
US

IV. Provider business mailing address

16414 SOUTHPARK DR
WESTFIELD IN
46074-8396
US

V. Phone/Fax

Practice location:
  • Phone: 317-815-5501
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number95000917A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: