Healthcare Provider Details

I. General information

NPI: 1740886266
Provider Name (Legal Business Name): KELSEY LYNN VODVARKA BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

519 W FERNWOOD DR
TORONTO OH
43964-1922
US

IV. Provider business mailing address

519 W FERNWOOD DR
TORONTO OH
43964-1922
US

V. Phone/Fax

Practice location:
  • Phone: 855-866-9893
  • Fax:
Mailing address:
  • Phone: 216-236-9004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-78633
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: