Healthcare Provider Details

I. General information

NPI: 1588141634
Provider Name (Legal Business Name): KRISTIN ANN RIALL BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2018
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

373 S WILLOW ST STE 266
MANCHESTER NH
03103-5751
US

IV. Provider business mailing address

8630 E 10TH AVE UNIT A
ANCHORAGE AK
99504-2209
US

V. Phone/Fax

Practice location:
  • Phone: 877-315-8080
  • Fax:
Mailing address:
  • Phone: 907-434-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number136016
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: