Provider Demographics
NPI:1750767521
Name:SCHLICHTING, KIRSTIN (BCBA)
Entity type:Individual
Prefix:MRS
First Name:KIRSTIN
Middle Name:
Last Name:SCHLICHTING
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 1:4547 OLNEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3612
Mailing Address - Country:US
Mailing Address - Phone:858-882-7484
Mailing Address - Fax:
Practice Address - Street 1:4547 OLNEY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-3612
Practice Address - Country:US
Practice Address - Phone:858-882-7484
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-19123103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst