Provider Demographics
NPI:1295006492
Name:RITTENHOUSE-SHAW, KRISTEN (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:RITTENHOUSE-SHAW
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 1:90 COMPARK RD STE D
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4982
Mailing Address - Country:US
Mailing Address - Phone:937-952-6379
Mailing Address - Fax:
Practice Address - Street 1:90 COMPARK RD STE D
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4982
Practice Address - Country:US
Practice Address - Phone:937-952-6379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-17-26603103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst