Provider Demographics
NPI:1811580806
Name:WITTE, KAITLYN RENEE (BCBA LBA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:RENEE
Last Name:WITTE
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 1:1303 CROWN JEWEL CIR
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-7673
Mailing Address - Country:US
Mailing Address - Phone:573-419-2276
Mailing Address - Fax:
Practice Address - Street 1:3420 HARRY S TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-4046
Practice Address - Country:US
Practice Address - Phone:636-926-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023028997103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst