Provider Demographics
NPI:1427292218
Name:HIME, KRISTEN (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:HIME
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:PO BOX 57389
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-7351
Mailing Address - Country:US
Mailing Address - Phone:312-498-5302
Mailing Address - Fax:
Practice Address - Street 1:3620 N CHRISTIANA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-4308
Practice Address - Country:US
Practice Address - Phone:312-498-5302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2014-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1-11-8861OtherBEHAVIOR ANALYST CERTIFICATION BOARD, INC.