Provider Demographics
NPI:1104215508
Name:TUCKER-RAMER, KACYN (BCBA)
Entity Type:Individual
Prefix:
First Name:KACYN
Middle Name:
Last Name:TUCKER-RAMER
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 1:920 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47305-1539
Mailing Address - Country:US
Mailing Address - Phone:765-587-5244
Mailing Address - Fax:765-281-6940
Practice Address - Street 1:920 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-1539
Practice Address - Country:US
Practice Address - Phone:765-587-5244
Practice Address - Fax:765-281-6940
Is Sole Proprietor?:No
Enumeration Date:2015-01-22
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-14-17576103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst