Individual
TRACIE ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
1519 BAXTER AVE, LOUISVILLE, KY 40205-1008
(502) 409-7181
Mailing address
8412 SABERDEE DR, LOUISVILLE, KY 40242-3030
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
ABALBA00222174
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-15-18299
BEHAVIOR ANALYSIS CERTIFICATION BOARD
KY
Enumeration date
09/16/2015
Last updated
09/16/2015
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