Provider Demographics
NPI:1821365115
Name:KUSS, BONNIE (MA, BCBA, COBA)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:KUSS
Suffix:
Gender:F
Credentials:MA, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 E KELSO RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-2312
Mailing Address - Country:US
Mailing Address - Phone:614-570-2323
Mailing Address - Fax:614-355-2220
Practice Address - Street 1:64 E KELSO RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-2312
Practice Address - Country:US
Practice Address - Phone:614-570-2323
Practice Address - Fax:614-355-2220
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid