Individual
JACLYN KALITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2505 E JEFFERSON BLVD, SOUTH BEND, IN 46615-2635
(574) 289-4831
(574) 234-2075
Mailing address
51960 GUMWOOD RD, GRANGER, IN 46530-6207
(574) 247-4665
(574) 247-4697
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-15-18130
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-15-18130
BCBA
CT
Enumeration date
08/17/2015
Last updated
08/17/2015
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