Provider Demographics
NPI:1487272597
Name:GIENOW, KORI RENEE (MA, LBS, BCBA)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:RENEE
Last Name:GIENOW
Suffix:
Gender:F
Credentials:MA, LBS, BCBA
Other - Prefix:
Other - First Name:KORI
Other - Middle Name:RENEE
Other - Last Name:KLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:283 S BUTLER RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-8939
Practice Address - Country:US
Practice Address - Phone:717-273-8871
Practice Address - Fax:717-270-2472
Is Sole Proprietor?:No
Enumeration Date:2020-07-07
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
PABH004833103K00000X
PA1-21-55224103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
15780710OtherCAQH ID
PABH004833OtherSTATE LICENSE