Individual
LORIEN KONETZKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
322 DUPONT DR STE C, SEYMOUR, IN 47274-1764
(317) 334-7331
Mailing address
451 S PARK RIDGE RD STE 102, BLOOMINGTON, IN 47401-8589
(812) 822-0189
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-16-23039
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300011450
—
IN
Enumeration date
10/18/2016
Last updated
06/04/2019
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