Healthcare Provider Details

I. General information

NPI: 1174097133
Provider Name (Legal Business Name): JANINE KESTERSON-CRAVENS PH.D, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2019
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 E DOUGLAS AVE STE 103
WICHITA KS
67206-2364
US

IV. Provider business mailing address

8118 E DOUGLAS AVE STE 103
WICHITA KS
67206-2364
US

V. Phone/Fax

Practice location:
  • Phone: 316-847-9824
  • Fax:
Mailing address:
  • Phone: 316-847-9824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number2317
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number028
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: