Provider Demographics
NPI:1295339828
Name:HAGGARD, KAITLIN NICOLE (BCBA, LBA, COBA)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:NICOLE
Last Name:HAGGARD
Suffix:
Gender:F
Credentials:BCBA, LBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8138
Mailing Address - Country:US
Mailing Address - Phone:502-233-9074
Mailing Address - Fax:
Practice Address - Street 1:51 CAVALIER BLVD STE 230
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-3967
Practice Address - Country:US
Practice Address - Phone:859-279-0143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOBA.00984103K00000X
KY267443103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst