Individual
MIRANDA RENAE THOMPSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., BCBA
Contact information
Practice address
6457 ELSINOR CT, BURLINGTON, KY 41005-7990
(859) 360-3006
Mailing address
925 DUDLEY PIKE, EDGEWOOD, KY 41017-8120
(859) 360-3006
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-46644
—
106S00000X
Behavior Technician
RBT-17-42418
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-20-46644
BCBA
—
Enumeration date
12/17/2019
Last updated
12/30/2020
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