Provider Demographics
NPI:1417102831
Name:DIEHL, KATHRYN (BCBA)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:DIEHL
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 1:1040 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-6077
Mailing Address - Country:US
Mailing Address - Phone:801-391-6258
Mailing Address - Fax:801-621-4667
Practice Address - Street 1:1040 CREEKSIDE DR
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-6077
Practice Address - Country:US
Practice Address - Phone:801-391-6258
Practice Address - Fax:801-621-4667
Is Sole Proprietor?:No
Enumeration Date:2008-11-26
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3330103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst