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Individual

KELLY KUSTOK

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
914 140TH AVE NE STE 201, BELLEVUE, WA 98005-3482
(855) 223-7123
Mailing address
PO BOX 740780, ATLANTA, GA 30374-0780
(855) 223-7123
(619) 374-7134

Taxonomy

Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
1-23-67055
NC
103K00000X
Behavior Analyst
1-23-67055
WA
103K00000X
Behavior Analyst
3657
NC
103K00000X
Behavior Analyst
Primary
BA61474114
WA

Other

Enumeration date
02/09/2018
Last updated
02/04/2026
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