Individual
KELLY LYNN UDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BSW, MA, BCBA, LBA
Contact information
Practice address
2032 E SQUARE LAKE RD, TROY, MI 48085-3338
(248) 672-8112
Mailing address
2032 E SQUARE LAKE RD, TROY, MI 48085-3338
(248) 672-8112
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
7401002039
MI
106S00000X
Behavior Technician
17-42943
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7401002039
BEHAVIOR ANALYST LICENSE
MI
05
—
MI11989
—
MI
Enumeration date
04/26/2019
Last updated
08/29/2023
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