Provider Demographics
NPI:1013257732
Name:KOBA-BURDT, KRISTEN (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:KOBA-BURDT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 LOINA PL
Mailing Address - Street 2:
Mailing Address - City:PAIA
Mailing Address - State:HI
Mailing Address - Zip Code:96779-8618
Mailing Address - Country:US
Mailing Address - Phone:808-250-8405
Mailing Address - Fax:
Practice Address - Street 1:640 LOINA PL
Practice Address - Street 2:
Practice Address - City:PAIA
Practice Address - State:HI
Practice Address - Zip Code:96779-8618
Practice Address - Country:US
Practice Address - Phone:808-250-8405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst