Provider Demographics
NPI:1477197382
Name:MCGONIGAL, KRISTIN PAIGE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:PAIGE
Last Name:MCGONIGAL
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985450 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-5450
Mailing Address - Country:US
Mailing Address - Phone:402-913-2320
Mailing Address - Fax:402-559-5737
Practice Address - Street 1:9012 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68127-3549
Practice Address - Country:US
Practice Address - Phone:402-913-2320
Practice Address - Fax:402-559-5737
Is Sole Proprietor?:No
Enumeration Date:2019-11-04
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NE0232103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician