Provider Demographics
NPI:1013419167
Name:NULTGREN, NATALIE A (RBT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:A
Last Name:NULTGREN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:A
Other - Last Name:HECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1253 JUDGE TYLER DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-1423
Mailing Address - Country:US
Mailing Address - Phone:931-449-0063
Mailing Address - Fax:
Practice Address - Street 1:1253 JUDGE TYLER DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-1423
Practice Address - Country:US
Practice Address - Phone:931-449-0063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRBT-17-29927106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNRBT-17-29927OtherBACB