Provider Demographics
NPI:1477874527
Name:HENRY, KRISTEN M (BCABA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:M
Last Name:HENRY
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51108-1320
Mailing Address - Country:US
Mailing Address - Phone:712-574-6648
Mailing Address - Fax:
Practice Address - Street 1:4501 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51108-1320
Practice Address - Country:US
Practice Address - Phone:712-574-6648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst