Provider Demographics
NPI:1861035974
Name:ROBINSON, KATELYN ANN (BCBA)
Entity type:Individual
Prefix:
First Name:KATELYN
Middle Name:ANN
Last Name:ROBINSON
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 1:45 BRIDGEWATER LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IL
Mailing Address - Zip Code:62249-5956
Mailing Address - Country:US
Mailing Address - Phone:815-508-4164
Mailing Address - Fax:
Practice Address - Street 1:45 BRIDGEWATER LN UNIT A
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IL
Practice Address - Zip Code:62249-5956
Practice Address - Country:US
Practice Address - Phone:815-508-4164
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1-19-37572103K00000X
1-19-37572103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty