Provider Demographics
NPI:1053767681
Name:HELMERS, KRISTIN PAULINE (MS, BCBA)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:PAULINE
Last Name:HELMERS
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1024 AVON ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54603-2503
Mailing Address - Country:US
Mailing Address - Phone:847-363-7328
Mailing Address - Fax:
Practice Address - Street 1:559 ZOR SHRINE PL
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-2068
Practice Address - Country:US
Practice Address - Phone:608-833-0123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI149-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI149-140OtherSTATE LICENSE
1-16-22078OtherBEHAVIOR ANALYST CERTIFICATION BOARD