Provider Demographics
NPI:1811267149
Name:RODRIGUEZ, KRISTEN OBERMEYER (EDS, BCBA)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:OBERMEYER
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:EDS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 RICHARDSON RD
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-6191
Mailing Address - Country:US
Mailing Address - Phone:850-865-0628
Mailing Address - Fax:850-892-7723
Practice Address - Street 1:556 RICHARDSON RD
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-6191
Practice Address - Country:US
Practice Address - Phone:850-865-0628
Practice Address - Fax:850-892-7723
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst