Individual
KELLY BENNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSW, BCBA, LBA
Contact information
Practice address
971 N GILBERT RD STE 101, GILBERT, AZ 85234-3481
(480) 559-8089
(317) 520-8200
Mailing address
3500 DEPAUW BLVD STE 3070, INDIANAPOLIS, IN 46268-6135
(855) 324-0885
(317) 520-8200
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BEH-001932
AZ
103K00000X
Behavior Analyst
Primary
—
—
106E00000X
Assistant Behavior Analyst
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-24-74994
BCBA CERTIFICATE
—
05
—
36-123419
—
IL
Enumeration date
06/04/2019
Last updated
07/28/2026
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