Individual
KORI RENEE GIENOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LBS, BCBA
Contact information
Practice address
283 S BUTLER RD, LEBANON, PA 17042-8939
(717) 273-8871
(717) 270-2472
Mailing address
785 5TH AVE STE 3, CHAMBERSBURG, PA 17201-4232
(717) 263-9555
(717) 709-6529
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH004833
PA
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15780710
CAQH ID
—
01
—
BH004833
STATE LICENSE
PA
Enumeration date
07/07/2020
Last updated
11/17/2022
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