Healthcare Provider Details

I. General information

NPI: 1043870660
Provider Name (Legal Business Name): KELSEY DENISE ISOM BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 10/05/2020
Certification Date: 10/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3213 SENECA ST
SAINT JOSEPH MO
64507-2026
US

IV. Provider business mailing address

3213 SENECA ST
SAINT JOSEPH MO
64507-2026
US

V. Phone/Fax

Practice location:
  • Phone: 816-752-7501
  • Fax:
Mailing address:
  • Phone: 816-752-7501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2019032712
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: