Provider Demographics
NPI:1154983070
Name:BROWN, KRISTIN MARIE (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:MARIE
Last Name:BROWN
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 1:4820 HEATH TRAILS RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-9600
Mailing Address - Country:US
Mailing Address - Phone:505-681-3224
Mailing Address - Fax:
Practice Address - Street 1:4820 HEATH TRAILS RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9600
Practice Address - Country:US
Practice Address - Phone:505-681-3224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1-19-34530103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst