Individual
KELSEY FAGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4780 ALEXANDRA LN, MACHESNEY PARK, IL 61115-7119
(815) 601-5588
Mailing address
4780 ALEXANDRA LN, MACHESNEY PARK, IL 61115-7119
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/25/2018
Last updated
06/25/2018
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