Provider Demographics
NPI:1396295275
Name:KRIGBAUM, RACHEL (BCBA)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:KRIGBAUM
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:GEMMILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:5143 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-1825
Mailing Address - Country:US
Mailing Address - Phone:913-475-1095
Mailing Address - Fax:
Practice Address - Street 1:5143 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-1825
Practice Address - Country:US
Practice Address - Phone:913-475-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-16-23676103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst