Provider Demographics
NPI:1760183834
Name:FRIEDRICH, KRISTINA DIANE (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:DIANE
Last Name:FRIEDRICH
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 1:616 LORI DR
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65233-1804
Mailing Address - Country:US
Mailing Address - Phone:573-881-4566
Mailing Address - Fax:
Practice Address - Street 1:1818 W WORLEY ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-1038
Practice Address - Country:US
Practice Address - Phone:573-881-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021009175103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst