Individual
MRS. KELLY ROBIN GANSARSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
279 LAUREL DR, TOBYHANNA, PA 18466-9503
(570) 561-9378
Mailing address
279 LAUREL DR, TOBYHANNA, PA 18466-9503
(570) 561-9378
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-03-1139
PA
Other
Enumeration date
04/03/2012
Last updated
04/03/2012
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