Individual
KELCY GILLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
29174 SW TOWN CENTER LOOP W STE 101, WILSONVILLE, OR 97070-9309
(971) 252-6155
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
(818) 345-2345
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
10187456
OR
Other
Enumeration date
12/20/2017
Last updated
12/20/2017
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