Provider Demographics
NPI:1457626319
Name:RAKUN, KRISTEN JEAN (MED BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JEAN
Last Name:RAKUN
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 1:7122 WOOD HOLLOW DR
Mailing Address - Street 2:APT 47
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2427
Mailing Address - Country:US
Mailing Address - Phone:612-636-0754
Mailing Address - Fax:
Practice Address - Street 1:7122 WOOD HOLLOW DR
Practice Address - Street 2:APT 47
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-2427
Practice Address - Country:US
Practice Address - Phone:612-636-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-12-10313103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst