Provider Demographics
NPI:1275005241
Name:NAKONECZNY, KRISTINA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:
Last Name:NAKONECZNY
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 1:9792 SPRING BROOKE CIR NW
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-8144
Mailing Address - Country:US
Mailing Address - Phone:330-671-3352
Mailing Address - Fax:
Practice Address - Street 1:9792 SPRING BROOKE CIR NW
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-8144
Practice Address - Country:US
Practice Address - Phone:330-671-3352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-01
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.00486103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst