Individual provider Active NPI

Brandie Ann Kretzschmar, BCBA

  • Behavior Analyst
  • Colorado Springs, CO
National Provider Identifier
1669912101
Registry record updated Mar 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-18-30034 Issued in CO
Practice address
1355 Garden of the Gods Road
Suite 150
Colorado Springs, CO 80907
Phone
(719) 212-6535
NPI assigned
Mar 2, 2017
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Developmental Therapist 222Q00000X
Behavior Analyst 103K00000X 1-18-30034 CO Primary

Addresses

Primary practice location

1355 Garden of the Gods Road
Suite 150
Colorado Springs, CO 80907

Mailing address

1355 Garden of the Gods Road
Suite 150
Colorado Springs, CO 80907
Phone (719) 212-6535

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Mga Behavior Therapy LLC CurrentSince Mar 13, 2022 Accepting new patients
Rand Speech Pathology LLC Behavior Analyst Past Accepting new patients

Locations

1355 Garden of the Gods Rd
Ste 150
Colorado Springs, CO 80907
Phone (719) 212-6535

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1488412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1669912101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1355 GARDEN OF THE GODS ROAD",
            "address_2": "SUITE 150",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80907",
            "telephone_number": "719-212-6535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1355 GARDEN OF THE GODS ROAD",
            "address_2": "SUITE 150",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "80907",
            "telephone_number": "719-212-6535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRETZSCHMAR",
        "first_name": "BRANDIE",
        "middle_name": "ANN",
        "name_prefix": "Mrs.",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-03-02",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "222Q00000X",
            "taxonomy_group": "",
            "desc": "Developmental Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CO",
            "license": "1-18-30034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.