Provider Demographics
NPI:1215321518
Name:RATLEDGE, KASSIDY (MA, BCBA, CBIS)
Entity type:Individual
Prefix:
First Name:KASSIDY
Middle Name:
Last Name:RATLEDGE
Suffix:
Gender:F
Credentials:MA, BCBA, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3240 PERALTA ST
Mailing Address - Street 2:#20
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-4129
Mailing Address - Country:US
Mailing Address - Phone:773-562-1503
Mailing Address - Fax:
Practice Address - Street 1:3240 PERALTA ST
Practice Address - Street 2:#20
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-4129
Practice Address - Country:US
Practice Address - Phone:773-562-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst