Provider Demographics
NPI:1992372742
Name:BARDIN, TEISHA BETH (BCBA)
Entity type:Individual
Prefix:
First Name:TEISHA
Middle Name:BETH
Last Name:BARDIN
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 1:608 W. STOCKTON ST.
Mailing Address - Street 2:
Mailing Address - City:EDMONTON
Mailing Address - State:KY
Mailing Address - Zip Code:42129
Mailing Address - Country:US
Mailing Address - Phone:270-646-8629
Mailing Address - Fax:
Practice Address - Street 1:1220 ASHLEY CIR
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3338
Practice Address - Country:US
Practice Address - Phone:859-554-2385
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-09
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1-25-78777103K00000X
KYRBT-21-169252106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst