Provider Demographics
NPI:1346854361
Name:GRUBER, KATELYN (MED, BCBA)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:
Last Name:GRUBER
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S CHEROKEE ST APT 3409
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80223-1955
Mailing Address - Country:US
Mailing Address - Phone:703-340-4900
Mailing Address - Fax:
Practice Address - Street 1:6795 E TENNESSEE AVE STE 427
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224-1699
Practice Address - Country:US
Practice Address - Phone:303-564-0751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2021-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-21-49119103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
BACB456565OtherBACB