Provider Demographics
NPI:1861002560
Name:LORENTZ, KENDRA (BCBA)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:LORENTZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:
Other - Last Name:CUTSFORTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:221 BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WI
Mailing Address - Zip Code:54822-8717
Mailing Address - Country:US
Mailing Address - Phone:715-600-3432
Mailing Address - Fax:
Practice Address - Street 1:221 BIRCH AVE
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:WI
Practice Address - Zip Code:54822-8717
Practice Address - Country:US
Practice Address - Phone:715-600-3432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WI1152103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician