MEDICARE: KRISTEN KIRCHNER M.ED, BCABA

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
1	106E00000X	Assistant Behavior Analyst		FL
2	103K00000X	Behavior Analyst	0-04-1324	FL

General Provider Information

NPI Number	:	1356741581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN KIRCHNER M.ED, BCABA

Provider Business Mailing Address
First Line	:	1825 EAGLE BEND TER
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-9507
Country	:	US
Telephone Number	:	904-583-3441
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 EAGLE BEND TER
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-9507
Country	:	US
Telephone Number	:	904-583-3441
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2014
Last Update Date	:	04/04/2019

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