Basic Information
| Provider Information | |||||||||
| NPI: | 1457999526 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FRYE | ||||||||
| FirstName: | KATELYN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3447 N HARPER DR | ||||||||
| Address2: | |||||||||
| City: | SOLSBERRY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474598264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8123275011 | ||||||||
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| Practice Location | |||||||||
| Address1: | 640 S WALKER ST STE A | ||||||||
| Address2: | |||||||||
| City: | BLOOMINGTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474032158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178819923 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2019 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | RBT-18-47602 | IN | N | 103K00000X | 1-22-60615 | IN | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.