Individual
KYLIE RAE DOMBROSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, BCBA, LBA
Contact information
Practice address
3761 JOHNSON HALL DR, MASONIC HOME, KY 40041-9998
(502) 633-1007
(502) 805-1511
Mailing address
90 HOWARD DR, SHELBYVILLE, KY 40065-8138
(502) 633-1007
(502) 805-1511
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
271493
KY
103K00000X
Behavior Analyst
—
—
106S00000X
Behavior Technician
RBT-19-99776
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-21-50514
BCBA CERTIFICATE
—
Enumeration date
09/30/2020
Last updated
10/27/2022
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