Healthcare Provider Details

I. General information

NPI: 1396218285
Provider Name (Legal Business Name): KEIRSTIE WINELAND MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 03/05/2024
Certification Date: 03/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CHURCH ST
PHILADELPHIA PA
19106-2201
US

IV. Provider business mailing address

46 COOPER RUN DR
CHERRY HILL NJ
08003-2207
US

V. Phone/Fax

Practice location:
  • Phone: 267-807-0550
  • Fax:
Mailing address:
  • Phone: 856-534-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-32408
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: