MEDICARE: CORRINE ANN KIRSCH M.S., 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
1	103TB0200X	Cognitive & Behavioral Psychologist	1-06-3103	WI
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1659544039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORRINE ANN KIRSCH M.S., BCBA

Provider Business Mailing Address
First Line	:	6660 DELMONICO DR STE D214
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1899
Country	:	US
Telephone Number	:	414-559-6678
Fax Number	:	719-592-1173

Provider Business Practice Location Address
First Line	:	408 W ROCKRIMMON BLVD UNIT A
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-1738
Country	:	US
Telephone Number	:	414-559-6678
Fax Number	:	719-213-2098

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

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	02/16/2022

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