Healthcare Provider Details

I. General information

NPI: 1730512724
Provider Name (Legal Business Name): KATIE MICHELLE KENDRICK BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12430 TESSON FERRY RD # 102
SAINT LOUIS MO
63128-2702
US

IV. Provider business mailing address

9348 KINGSMOUNT DR APT B
SAINT LOUIS MO
63123-4195
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2013029021
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: