Provider Demographics
NPI:1033503016
Name:HANSEN, KRISTAL JEAN (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:JEAN
Last Name:HANSEN
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 1:10525 E CONNOR RD
Mailing Address - Street 2:
Mailing Address - City:VALLEYFORD
Mailing Address - State:WA
Mailing Address - Zip Code:99036-9703
Mailing Address - Country:US
Mailing Address - Phone:509-389-5248
Mailing Address - Fax:
Practice Address - Street 1:801 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2225
Practice Address - Country:US
Practice Address - Phone:509-835-4404
Practice Address - Fax:509-835-4400
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARBT-15-11512106S00000X
WA12042297103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician