Individual
KELLY WICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
2475 W CHICAGO ST, RAPID CITY, SD 57702-2467
(605) 206-5004
(605) 646-4840
Mailing address
2475 W CHICAGO ST, RAPID CITY, SD 57702-2467
(605) 206-5004
(605) 646-4840
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-21-157217
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-21-157217
RBT
—
Enumeration date
02/23/2021
Last updated
02/23/2021
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