Individual
AUTUMN DAWN KOSTKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
3335 LT MOSS RD, MISSOULA, MT 59804-7222
(406) 549-6413
(406) 542-0143
Mailing address
3335 LT MOSS RD, MISSOULA, MT 59804-7222
(406) 549-6413
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-17-35537
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-17-35537
BEHAVIOR ANALYST CERTIFICATION BOARD
—
Enumeration date
08/18/2020
Last updated
08/18/2020
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