Individual
KELLY PARKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
4655 ROSEBUD LN, NEWBURGH, IN 47630
(812) 213-8031
(765) 454-9759
Mailing address
3500 DEPAUW BOULEVARD, SUITE 3070, EVANSVILLE, IN 46268-6135
(855) 324-0885
(765) 454-9759
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-29633
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-18-29663
BCBA LICENSE
IN
Enumeration date
04/05/2018
Last updated
06/25/2018
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