Individual
KAILEY KENDALL ROUSSIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA, LBA
Contact information
Practice address
1314 RIVERLAND RD SE, ROANOKE, VA 24014-3610
(866) 565-7222
(877) 734-1914
Mailing address
2 VILLAGE SQ STE 210, BALTIMORE, MD 21210-1624
(866) 565-7222
(877) 734-1914
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
0133001369
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194397273
—
VA
Enumeration date
07/16/2021
Last updated
03/04/2024
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