Individual
KELLEY LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7049 PERSHING AVE, SAINT LOUIS, MO 63130-4319
(205) 490-5364
Mailing address
306 N KENSINGTON AVE, LA GRANGE PARK, IL 60526-1870
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
02/05/2020
Last updated
02/05/2020
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