Provider Demographics
NPI:1871183012
Name:PFAFFL, KIANDRA MERCEDES (RBT)
Entity Type:Individual
Prefix:
First Name:KIANDRA
Middle Name:MERCEDES
Last Name:PFAFFL
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:KIANDRA
Other - Middle Name:M
Other - Last Name:PFAFFL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1590 GATEHOUSE CIR N APT 103
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-2908
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2001 HOYT ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215-1639
Practice Address - Country:US
Practice Address - Phone:920-857-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-19-99864106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician