Provider Demographics
NPI:1326846361
Name:MATTER-POEHLEIN, KRYSTA (BCBA)
Entity type:Individual
Prefix:
First Name:KRYSTA
Middle Name:
Last Name:MATTER-POEHLEIN
Suffix:
Gender:
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:569 CARTER CT
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136-2201
Mailing Address - Country:US
Mailing Address - Phone:920-418-0090
Mailing Address - Fax:
Practice Address - Street 1:569 CARTER CT
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136-2201
Practice Address - Country:US
Practice Address - Phone:920-739-3009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst