Provider Demographics
NPI:1083149264
Name:WILLIAMSON, KENDRA (BCBA)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:LYKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:DEPT 781625
Mailing Address - Street 2:P.O. BOX 78000
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1625
Mailing Address - Country:US
Mailing Address - Phone:614-355-8004
Mailing Address - Fax:614-355-2220
Practice Address - Street 1:187 W SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081
Practice Address - Country:US
Practice Address - Phone:614-355-7500
Practice Address - Fax:614-355-7533
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 171M00000X, 390200000X
OH1-22-57680103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid