Provider Demographics
NPI:1518111822
Name:SKOUSGARD, KRISTIN ELIZABETH (BCBA)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:ELIZABETH
Last Name:SKOUSGARD
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 1:230 S. SUSSEX LN
Mailing Address - Street 2:#4
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018
Mailing Address - Country:US
Mailing Address - Phone:901-624-6369
Mailing Address - Fax:
Practice Address - Street 1:230 S. SUSSEX LN
Practice Address - Street 2:#4
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018
Practice Address - Country:US
Practice Address - Phone:901-624-6369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst