Individual
KELSEY SPROUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1010 MARQUEZ PL, UNIT D, SANTA FE, NM 87505-1693
(505) 501-8485
Mailing address
21600 OXNARD ST, SUITE 1800, WOODLAND HILLS, CA 91367-4976
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
NM
Other
Enumeration date
04/12/2017
Last updated
07/24/2017
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