Individual
KELLY JO MINOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2248 NW 164TH ST, EDMOND, OK 73013-8801
(405) 562-3776
(405) 562-3313
Mailing address
2248 NW 164TH ST, EDMOND, OK 73013-8801
(405) 562-3776
(405) 562-3313
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-21-52873
OK
Other
Enumeration date
01/20/2022
Last updated
01/20/2022
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