Provider Demographics
NPI:1295094258
Name:KOCH, KRISTINE L (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:KOCH
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5860 GOLDEN GATE PKWY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-7459
Mailing Address - Country:US
Mailing Address - Phone:239-352-7600
Mailing Address - Fax:239-352-7609
Practice Address - Street 1:5860 GOLDEN GATE PKWY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-7459
Practice Address - Country:US
Practice Address - Phone:239-352-7600
Practice Address - Fax:239-352-7609
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-11-8228103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst