Provider Demographics
NPI:1215552401
Name:KARDATZKE, ERIKA SKYLER (MA BCBA)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:SKYLER
Last Name:KARDATZKE
Suffix:
Gender:F
Credentials:MA BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 RIVER STREET
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05156-2226
Mailing Address - Country:US
Mailing Address - Phone:802-886-4500
Mailing Address - Fax:802-886-4560
Practice Address - Street 1:132 SO. MAIN STREET
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JCT.
Practice Address - State:VT
Practice Address - Zip Code:05001
Practice Address - Country:US
Practice Address - Phone:802-295-3031
Practice Address - Fax:802-281-7080
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NH1-23-64006103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician