Individual
KELLY J SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
986 LAKEVIEW DR, GREEN BAY, WI 54313-8818
(920) 544-4970
Mailing address
986 LAKEVIEW DR, GREEN BAY, WI 54313-8818
(920) 544-4970
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
213-140
WI
Other
Enumeration date
02/06/2018
Last updated
02/06/2018
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