Individual
KELLY PHELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, BCBA
Contact information
Practice address
11914 S ROUTE 59 UNIT 124, PLAINFIELD, IL 60585
(815) 469-1500
Mailing address
11914 S ROUTE 59 UNIT 124, PLAINFIELD, IL 60585-5110
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-20-44141
—
106S00000X
Behavior Technician
RBT-16-26776
AZ
Other
Enumeration date
02/02/2018
Last updated
08/27/2020
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