Individual
KAITLYN BRADSHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
745 10TH ST STE C, ROCK VALLEY, IA 51247-1511
(712) 454-3484
Mailing address
1105 W RUSSELL ST, SIOUX FALLS, SD 57104-1322
(605) 271-2690
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-45677
LA
106S00000X
Behavior Technician
RBT-18-57026
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2455559
—
LA
Enumeration date
08/20/2018
Last updated
07/12/2021
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