Individual
KIRSTIE TANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
2703 SE OTIS CORLEY DR, BENTONVILLE, AR 72712-3864
(917) 905-0139
Mailing address
2703 SE OTIS CORLEY DR, BENTONVILLE, AR 72712-3864
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-50902
CA
Other
Enumeration date
07/23/2021
Last updated
07/23/2021
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