Healthcare Provider Details

I. General information

NPI: 1811659469
Provider Name (Legal Business Name): BRIANNA HETRICK BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 ASHLEY CIR
BOWLING GREEN KY
42104-3338
US

IV. Provider business mailing address

1220 ASHLEY CIR
BOWLING GREEN KY
42104-3338
US

V. Phone/Fax

Practice location:
  • Phone: 855-444-5664
  • Fax: 512-842-7446
Mailing address:
  • Phone: 855-444-5664
  • Fax: 512-842-7446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number309918
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: