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General NPI Number Information
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NPI Number | 1104321769
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Entity Type | Individual
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Provider Name | KAITLYN MICHELLE ANDERSON BCBA
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Gender | Female
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1582 N WAGGONER RD STE A
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City | BLACKLICK
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State | OH
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Zip | 43004-8669
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Country | US
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Telephone | 614-344-0419
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Fax |
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Provider Business Mailing Address
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Address Line | 390 UNION BLVD STE 300
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City | LAKEWOOD
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State | CO
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Zip | 80228-6514
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Country | US
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Telephone | 303-989-8169
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Fax | 303-984-4366
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 11831816
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License Number State | OH
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