Healthcare Provider Details

I. General information

NPI: 1467372821
Provider Name (Legal Business Name): KEELY BALLARD MA, BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KEELY JOHNSON

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CORPORATE PKWY
BUFFALO NY
14226-1200
US

IV. Provider business mailing address

PO BOX 274
COLLINS CENTER NY
14035-0274
US

V. Phone/Fax

Practice location:
  • Phone: 716-775-2299
  • Fax:
Mailing address:
  • Phone: 716-449-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number005139
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: