Provider Demographics
NPI:1154955110
Name:ZIOMKOWSKI, KAITLIN (BCBA, LBA, COBA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:ZIOMKOWSKI
Suffix:
Gender:
Credentials:BCBA, LBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 CROSSHALL PL
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7115
Mailing Address - Country:US
Mailing Address - Phone:513-295-1850
Mailing Address - Fax:
Practice Address - Street 1:6196 LAKE GRAY BLVD STE 116
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5867
Practice Address - Country:US
Practice Address - Phone:800-356-4049
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-28
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
12156967103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst