Individual
KELLY DIFULVIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
1128 N CAMDEN LN, SOUTH ELGIN, IL 60177-2850
(847) 312-7147
Mailing address
1128 N CAMDEN LN, SOUTH ELGIN, IL 60177-2850
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
18-47503
IL
Other
Enumeration date
05/15/2018
Last updated
05/15/2018
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