Provider Demographics
NPI:1629887666
Name:RAKER, KATLYN (BCBA)
Entity type:Individual
Prefix:
First Name:KATLYN
Middle Name:
Last Name:RAKER
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 1:435 LONGLEAF DR
Mailing Address - Street 2:
Mailing Address - City:PERKASIE
Mailing Address - State:PA
Mailing Address - Zip Code:18944-5418
Mailing Address - Country:US
Mailing Address - Phone:570-377-0597
Mailing Address - Fax:
Practice Address - Street 1:435 LONGLEAF DR
Practice Address - Street 2:
Practice Address - City:PERKASIE
Practice Address - State:PA
Practice Address - Zip Code:18944-5418
Practice Address - Country:US
Practice Address - Phone:570-377-0597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH006401103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst