Individual
KELLY PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
3030 LAKE AVE STE 20, FORT WAYNE, IN 46805-5428
(260) 420-9332
(866) 446-0198
Mailing address
4103 CASTELL DR, FORT WAYNE, IN 46835-2100
(765) 730-3691
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-31563
IN
Other
Enumeration date
05/29/2018
Last updated
02/15/2019
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