Individual
KELLI JO DAWN WEAVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, BHRS
Contact information
Practice address
124 E 6TH ST, PAWHUSKA, OK 74056-4204
(918) 604-6054
(918) 777-9018
Mailing address
124 E 6TH ST, PAWHUSKA, OK 74056-4204
(918) 604-6054
(918) 777-9018
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/29/2012
Last updated
06/28/2022
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