Provider Demographics
NPI:1295373595
Name:WILKINSON, KRISTEN L (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:WILKINSON
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18904 GROTTO LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-1854
Mailing Address - Country:US
Mailing Address - Phone:240-246-4173
Mailing Address - Fax:
Practice Address - Street 1:10810 DARNESTOWN RD STE 201
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2603
Practice Address - Country:US
Practice Address - Phone:240-252-4105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA733103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty