Provider Demographics
NPI:1528885068
Name:DIETRICH, KATHLEEN (BCBA)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:DIETRICH
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 1:131 W HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:504-553-1113
Practice Address - Street 1:131 W HARRISON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70124-1301
Practice Address - Country:US
Practice Address - Phone:504-264-7079
Practice Address - Fax:504-553-1113
Is Sole Proprietor?:No
Enumeration Date:2024-09-25
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL-882103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst