Provider Demographics
NPI:1164767505
Name:HOSIE, KRISTEN (MS, CCSOT, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:HOSIE
Suffix:
Gender:F
Credentials:MS, CCSOT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7955 S MARK RD
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-9524
Mailing Address - Country:US
Mailing Address - Phone:503-758-2975
Mailing Address - Fax:
Practice Address - Street 1:2260 JUDSON ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-1273
Practice Address - Country:US
Practice Address - Phone:503-758-2975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORSTB- T-10129963101YM0800X
ORABAB10174694103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health