Provider Demographics
NPI:1467937920
Name:WENDLING, KIMBERLEY (MSED,BCBA,LABA)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:WENDLING
Suffix:
Gender:F
Credentials:MSED,BCBA,LABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 RIVERDALE ST UNIT 286
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-4900
Mailing Address - Country:US
Mailing Address - Phone:413-358-7326
Mailing Address - Fax:
Practice Address - Street 1:900 RIVERDALE ST UNIT 286
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-4900
Practice Address - Country:US
Practice Address - Phone:413-358-7326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA237103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst