Provider Demographics
NPI:1629537360
Name:FOX, KAITLIN ASHLEY (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ASHLEY
Last Name:FOX
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15171 SE ASTON LOOP
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-7876
Mailing Address - Country:US
Mailing Address - Phone:949-573-3165
Mailing Address - Fax:
Practice Address - Street 1:11301 SE 10TH ST APT 104
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-6119
Practice Address - Country:US
Practice Address - Phone:949-573-3165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-37214103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst