Provider Demographics
NPI:1881273233
Name:BURKHOLDER, KRISTEN JOAN (MS, BCBA, LBA-VT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JOAN
Last Name:BURKHOLDER
Suffix:
Gender:
Credentials:MS, BCBA, LBA-VT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 LILY LN APT 1
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-8486
Mailing Address - Country:US
Mailing Address - Phone:802-696-2295
Mailing Address - Fax:
Practice Address - Street 1:25 LILY LN APT 1
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-8486
Practice Address - Country:US
Practice Address - Phone:802-696-2295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-05
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT146.0134210103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1881273233Medicaid