Individual
KENNAN JAY LISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
12175 VISIONARY WAY STE 800, FISHERS, IN 46038-3069
(463) 777-5914
Mailing address
12175 VISIONARY WAY STE 800, FISHERS, IN 46038-3069
(463) 777-5914
(463) 800-3415
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S
—
FL
Enumeration date
02/27/2018
Last updated
08/04/2026
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