1194178335 NPI number — MRS. KATLYN DOROTHY FREED BCBA, LBA

Table of content: MRS. KATLYN DOROTHY FREED BCBA, LBA (NPI 1194178335)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194178335 NPI number — MRS. KATLYN DOROTHY FREED BCBA, LBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FREED
Provider First Name:
KATLYN
Provider Middle Name:
DOROTHY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA, LBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ALTIC
Provider Other First Name:
KATLYN
Provider Other Middle Name:
DOROTHY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194178335
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11111 M ST STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68137-2378
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-235-8120
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11111 M ST STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68137-2378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-235-8120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X , with the licence number: 0631 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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