Provider Demographics
NPI:1972119337
Name:SCHARES, KAITLYN LEA (BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LEA
Last Name:SCHARES
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:IA
Mailing Address - Zip Code:50644-2936
Mailing Address - Country:US
Mailing Address - Phone:319-830-5940
Mailing Address - Fax:
Practice Address - Street 1:1661 BOYSON SQUARE DR
Practice Address - Street 2:
Practice Address - City:HIAWATHA
Practice Address - State:IA
Practice Address - Zip Code:52233-2344
Practice Address - Country:US
Practice Address - Phone:319-830-5940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA101032103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA101032OtherIOWA LICENSURE
1-20-43382OtherBACB (BEHAVIOR ANALYST CERTIFICATION BOARD)