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NPI Code Detail

MEDICARE: KRYSTLE ANDERSON MA, BCBA

MEDICARE: KRYSTLE ANDERSON MA, BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst2012039557MO

General Provider Information

NPI Number : 1124363544
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTLE ANDERSON MA, BCBA
Provider Business Mailing Address
First Line : 8710 EULALIE AVE
Second Line :
City : BRENTWOOD
State : MO
Zip : 63144-2012
Country : US
Telephone Number : 314-486-2311
Fax Number :
Provider Business Practice Location Address
First Line : 650 OFFICE PKWY
Second Line :
City : CREVE COEUR
State : MO
Zip : 63141-7103
Country : US
Telephone Number : 314-486-2311
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/11/2012
Last Update Date : 10/22/2019

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