Provider Demographics
NPI:1689066565
Name:KASCHUB, KRISTIN ARLENE JENNY (MS BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ARLENE JENNY
Last Name:KASCHUB
Suffix:
Gender:F
Credentials:MS BCBA
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:ARLENE
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS BCBA
Mailing Address - Street 1:13652 DERBY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-8028
Mailing Address - Country:US
Mailing Address - Phone:847-754-1718
Mailing Address - Fax:
Practice Address - Street 1:13652 DERBY LINE RD
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-8028
Practice Address - Country:US
Practice Address - Phone:847-754-1718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
IL1-14-17389171W00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171W00000XOther Service ProvidersContractor