Healthcare Provider Details

I. General information

NPI: 1275893745
Provider Name (Legal Business Name): KRISTEN ANN PRIEM BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2814 WOODCLIFF CIR SE
GRAND RAPIDS MI
49506-3155
US

IV. Provider business mailing address

2814 WOODCLIFF CIR SE
GRAND RAPIDS MI
49506-3155
US

V. Phone/Fax

Practice location:
  • Phone: 616-780-1358
  • Fax:
Mailing address:
  • Phone: 616-780-1358
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: