Provider Demographics
NPI:1659544039
Name:KIRSCH, CORRINE ANN (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:CORRINE
Middle Name:ANN
Last Name:KIRSCH
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6660 DELMONICO DR STE D214
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1899
Mailing Address - Country:US
Mailing Address - Phone:414-559-6678
Mailing Address - Fax:719-592-1173
Practice Address - Street 1:408 W ROCKRIMMON BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1738
Practice Address - Country:US
Practice Address - Phone:414-559-6678
Practice Address - Fax:719-213-2098
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1-06-3103103TB0200X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral