Provider Demographics
NPI:1598091449
Name:BANKER BIERKAN, LAURA (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:
Last Name:BANKER BIERKAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:BANKER
Other - Last Name:BIERKAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:12161 BROOKWAY DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-1467
Mailing Address - Country:US
Mailing Address - Phone:513-417-1595
Mailing Address - Fax:
Practice Address - Street 1:12161 BROOKWAY DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-1467
Practice Address - Country:US
Practice Address - Phone:513-417-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-28
Last Update Date:2009-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-05-2568103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst