Provider Demographics
NPI:1568947638
Name:KOSMACEK, KYLIE (BCBA)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:KOSMACEK
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 1:522 S 130TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-2908
Mailing Address - Country:US
Mailing Address - Phone:402-320-6650
Mailing Address - Fax:
Practice Address - Street 1:909 S 76TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4519
Practice Address - Country:US
Practice Address - Phone:402-390-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1-14-16557103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst