Provider Demographics
NPI:1629359138
Name:TETREAULT, ALLISON SERRA (PHD, BCBA-D)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:SERRA
Last Name:TETREAULT
Suffix:
Gender:F
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-3149
Mailing Address - Country:US
Mailing Address - Phone:785-304-3317
Mailing Address - Fax:
Practice Address - Street 1:2125 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-3149
Practice Address - Country:US
Practice Address - Phone:785-304-3317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-30
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1084194103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst