Provider Demographics
NPI:1699224840
Name:KROELINGER, VASUDA BANGALORE (BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:VASUDA
Middle Name:BANGALORE
Last Name:KROELINGER
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 1:185 CHATEAU DR SW STE 101
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-7415
Mailing Address - Country:US
Mailing Address - Phone:256-666-0477
Mailing Address - Fax:256-666-0465
Practice Address - Street 1:185 CHATEAU DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-666-0477
Practice Address - Fax:256-666-0465
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-29
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1-16-23484103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst