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General NPI Number Information
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NPI Number | 1730906645
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Entity Type | Individual
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Provider Name | KRISTEN DAE FREER BCBA
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Gender | Female
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Dates
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Enumeration Date | 09/23/2024
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Last Update Date | 09/23/2024
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Provider Practice Location Address
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Address Line | 418 FAIRGROUND RD
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City | NEOSHO
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State | MO
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Zip | 64850-1626
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Country | US
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Telephone | 417-451-8600
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Fax |
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Provider Business Mailing Address
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Address Line | 2095 S SUNSHINE DR
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City | JOPLIN
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State | MO
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Zip | 64801-9799
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Country | US
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Telephone | 417-291-4442
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2024038471
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License Number State | MO
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