Provider Demographics
NPI:1033728753
Name:FLOSS, KRISTIN NICHOL (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:NICHOL
Last Name:FLOSS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1542 INDUSTRIAL DR
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-3842
Mailing Address - Country:US
Mailing Address - Phone:920-209-3166
Mailing Address - Fax:
Practice Address - Street 1:1542 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-3842
Practice Address - Country:US
Practice Address - Phone:920-209-3166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI380-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst