Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | 1-20-40679 | CO |
NPI | 1003462110 |
---|---|
Provider Name | Kelly Inglisa |
First Address | Colorado Springs, CO 80909-1842 |
Second Address | Omaha, NE 68102-1857 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2019 |
Last Update Date | 17/08/2021 |