Provider Demographics
NPI:1548620248
Name:GENGO GAJESKI, KRISTA (MA, BCBA, LBA)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:GENGO GAJESKI
Suffix:
Gender:F
Credentials:MA, BCBA, LBA
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:GENGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:253 BROOKHAVEN TRL
Mailing Address - Street 2:
Mailing Address - City:PINGREE GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-9161
Mailing Address - Country:US
Mailing Address - Phone:972-742-6596
Mailing Address - Fax:
Practice Address - Street 1:5631 DURALEIGH RD,
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612
Practice Address - Country:US
Practice Address - Phone:919-444-0668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-24
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-15-18452103K00000X
TX11518452103K00000X
NC2539103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst