Provider Demographics
NPI:1902414303
Name:KOLODZIEJ, BRITTANY DAWN (BCBA)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:DAWN
Last Name:KOLODZIEJ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:LOVELACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:835 PROTON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4203
Mailing Address - Country:US
Mailing Address - Phone:512-772-4042
Mailing Address - Fax:512-842-7446
Practice Address - Street 1:835 PROTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4203
Practice Address - Country:US
Practice Address - Phone:512-772-4042
Practice Address - Fax:512-842-7446
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-23-70299103K00000X
TXRBT-20-121712106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician