Provider Demographics
NPI:1124608757
Name:STREETER, KATY (BCBA)
Entity type:Individual
Prefix:
First Name:KATY
Middle Name:
Last Name:STREETER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17331 S WALTER ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-9162
Mailing Address - Country:US
Mailing Address - Phone:913-271-5152
Mailing Address - Fax:
Practice Address - Street 1:17331 S WALTER ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-9162
Practice Address - Country:US
Practice Address - Phone:913-271-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12148559103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst