Katelyn Datsko

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-21-52663 Issued in GA

Practice address

1630 Peachtree Industrial Blvd Apt 1109
Suwanee, GA 30024-5576

Phone

(586) 871-7019

NPI assigned

Sep 6, 2018

Reactivated

Oct 14, 2019

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1536192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630886400000",
    "number": "1962984971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1630 PEACHTREE INDUSTRIAL BLVD APT 1109",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300245576",
            "telephone_number": "586-871-7019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1630 PEACHTREE INDUSTRIAL BLVD APT 1109",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300245576",
            "telephone_number": "586-871-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DATSKO",
        "first_name": "KATELYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-09-06",
        "last_updated": "2021-09-06",
        "certification_date": "2021-09-06",
        "deactivation_date": "2018-10-06",
        "reactivation_date": "2019-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "MI",
            "license": "18-64273",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "GA",
            "license": "1-21-52663",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Jones, D.M.D., P.C.
• Alexander Randolph Daley, DPT
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• David M. Richardson P.C. (Richardson Chiropractic & Wellness)
• David R. Lesch, M.D., LLC (Georgia Neurology and Sleep Medicine Assoc)
• Brooke Davidson
• Elizabeth Jane Davies, RPH
• Cindy J Davis, OTR/L

• Behavior Analyst in Suwanee, GA
• Providers in Suwanee, GA by specialty
• Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2021; 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.