Provider Demographics
NPI:1619717303
Name:REITZEL, KATIE ANN (BCBA)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:ANN
Last Name:REITZEL
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 1:2 VILLAGE SQ STE 210
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-1624
Mailing Address - Country:US
Mailing Address - Phone:609-525-4271
Mailing Address - Fax:443-743-3863
Practice Address - Street 1:6660 DOUBLETREE AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1128
Practice Address - Country:US
Practice Address - Phone:614-844-5433
Practice Address - Fax:614-987-8643
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-24-74611103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst