Provider Demographics
NPI:1730906645
Name:FREER, KRISTEN DAE (BCBA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:DAE
Last Name:FREER
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 1:2095 S SUNSHINE DR
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-9799
Mailing Address - Country:US
Mailing Address - Phone:417-291-4442
Mailing Address - Fax:
Practice Address - Street 1:418 FAIRGROUND RD
Practice Address - Street 2:
Practice Address - City:NEOSHO
Practice Address - State:MO
Practice Address - Zip Code:64850-1626
Practice Address - Country:US
Practice Address - Phone:417-451-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024038471103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst