Provider Demographics
NPI:1295339828
Name:HAGGARD, KAITLIN NICOLE (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:NICOLE
Last Name:HAGGARD
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 ORPHANAGE RD
Mailing Address - Street 2:
Mailing Address - City:FT MITCHELL
Mailing Address - State:KY
Mailing Address - Zip Code:41017-3006
Mailing Address - Country:US
Mailing Address - Phone:859-331-0880
Mailing Address - Fax:855-719-0501
Practice Address - Street 1:71 ORPHANAGE RD
Practice Address - Street 2:
Practice Address - City:FT MITCHELL
Practice Address - State:KY
Practice Address - Zip Code:41017-3006
Practice Address - Country:US
Practice Address - Phone:859-331-0880
Practice Address - Fax:855-719-0501
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY267443103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst