Provider Demographics
NPI:1679028153
Name:SCHULTZ, KENDRA BRYNN (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KENDRA
Middle Name:BRYNN
Last Name:SCHULTZ
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 1:1075 N CORONA ST
Mailing Address - Street 2:APT 311
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2977
Mailing Address - Country:US
Mailing Address - Phone:516-318-9309
Mailing Address - Fax:
Practice Address - Street 1:11111 E MISSISSIPPI AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3106
Practice Address - Country:US
Practice Address - Phone:303-214-3365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-15-17910103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst