Provider Demographics
NPI:1932333762
Name:KONDRAD, ANN MARIE (MA, BCBA, BSL)
Entity Type:Individual
Prefix:MRS
First Name:ANN MARIE
Middle Name:
Last Name:KONDRAD
Suffix:
Gender:F
Credentials:MA, BCBA, BSL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 OHM AVE
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-4611
Mailing Address - Country:US
Mailing Address - Phone:715-514-2555
Mailing Address - Fax:715-514-2048
Practice Address - Street 1:1620 OHM AVE
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4611
Practice Address - Country:US
Practice Address - Phone:715-514-2555
Practice Address - Fax:715-514-2048
Is Sole Proprietor?:No
Enumeration Date:2009-05-07
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH0014103K00000X
103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst