Provider Demographics
NPI:1215427216
Name:PATTISON, ANNIKA LYNN
Entity type:Individual
Prefix:
First Name:ANNIKA
Middle Name:LYNN
Last Name:PATTISON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 PLAYERS CIR APT 45
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-2635
Mailing Address - Country:US
Mailing Address - Phone:850-499-3878
Mailing Address - Fax:
Practice Address - Street 1:1133 COLLEGE AVE STE E230
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2818
Practice Address - Country:US
Practice Address - Phone:785-587-1825
Practice Address - Fax:785-587-1828
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF6937606103K00000X
KSRBT-19-94005103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst