Provider Demographics
NPI:1215429923
Name:GAUL, KRISTINA MARIA (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:MARIA
Last Name:GAUL
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 1:1314 N. HIAWATHA
Mailing Address - Street 2:
Mailing Address - City:PIPESTONE
Mailing Address - State:MN
Mailing Address - Zip Code:56164-2282
Mailing Address - Country:US
Mailing Address - Phone:507-825-5858
Mailing Address - Fax:
Practice Address - Street 1:1020 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-4707
Practice Address - Country:US
Practice Address - Phone:605-444-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-30
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD018-ABA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst