Provider Demographics
NPI:1922367796
Name:FRY, KAREN E (MA, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:FRY
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9505 DORISANN CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-6303
Mailing Address - Country:US
Mailing Address - Phone:314-544-7754
Mailing Address - Fax:
Practice Address - Street 1:9505 DORISANN CT
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63123-6303
Practice Address - Country:US
Practice Address - Phone:314-544-7754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-14
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011037276103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst