Provider Demographics
NPI:1306517933
Name:KIDDOS ABA THERAPY, LLC
Entity type:Organization
Organization Name:KIDDOS ABA THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COFOUNDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-796-0306
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:KALIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45853-0415
Mailing Address - Country:US
Mailing Address - Phone:419-796-0306
Mailing Address - Fax:
Practice Address - Street 1:415 OTTAWA ROAD
Practice Address - Street 2:
Practice Address - City:KALIDA
Practice Address - State:OH
Practice Address - Zip Code:45853-4585
Practice Address - Country:US
Practice Address - Phone:419-796-0306
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty