Provider Demographics
NPI:1598043838
Name:PENCE, KAITLIN ANN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:ANN
Last Name:PENCE
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 1:1004 RAYMOND CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-8418
Mailing Address - Country:US
Mailing Address - Phone:203-482-5613
Mailing Address - Fax:
Practice Address - Street 1:810 WESTWOOD OFFICE PARK
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5121
Practice Address - Country:US
Practice Address - Phone:540-424-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-03
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-13927103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst