Individual
BRYNNAN NICOLE KELLOGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
601 NOBLE DR, FORT WAYNE, IN 46825-5544
(260) 420-9332
Mailing address
3212 COUNTY ROAD 53, BUTLER, IN 46721-9615
(260) 645-0035
(260) 645-0035
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-26-2830510
IN
Other
Enumeration date
07/23/2026
Last updated
07/23/2026
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