Provider Demographics
NPI:1700461092
Name:WESTERBERG, KAITLYN LEEANN (BCBA, MED)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:LEEANN
Last Name:WESTERBERG
Suffix:
Gender:F
Credentials:BCBA, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 E 13TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-1015
Mailing Address - Country:US
Mailing Address - Phone:407-404-3084
Mailing Address - Fax:
Practice Address - Street 1:13405 SADDLE BACK PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-6149
Practice Address - Country:US
Practice Address - Phone:512-962-5543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician