Provider Demographics
NPI:1093418998
Name:ELLIS, KAITLIN (BCBA)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:ELLIS
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 1:115 WINNIPESAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NH
Mailing Address - Zip Code:03235-1922
Mailing Address - Country:US
Mailing Address - Phone:603-998-8297
Mailing Address - Fax:603-968-7455
Practice Address - Street 1:23 WEST ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:NH
Practice Address - Zip Code:03217-4219
Practice Address - Country:US
Practice Address - Phone:603-968-7452
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-22
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1-23-64648103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst