Provider Demographics
NPI:1700078623
Name:HUSTYI, KRISTIN MARIE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:MARIE
Last Name:HUSTYI
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 1:85 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-8001
Mailing Address - Country:US
Mailing Address - Phone:734-646-6547
Mailing Address - Fax:
Practice Address - Street 1:2723 S STATE ST
Practice Address - Street 2:SUITE 150
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-6188
Practice Address - Country:US
Practice Address - Phone:734-646-6547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1-11-8985103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-11-8985OtherBEHAVIOR ANALYST CERTIFICATION BOARD