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General NPI Number Information
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NPI Number | 1386009223
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Entity Type | Individual
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Provider Name | KELSEY KHARRAZI BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 6414 W NORTH AVE
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City | CHICAGO
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State | IL
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Zip | 60707
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Country | US
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Telephone | 312-554-5578
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Fax | 877-372-2427
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Provider Business Mailing Address
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Address Line | 12040 98TH AVE NE STE 204
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City | KIRKLAND
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State | WA
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Zip | 98034-4290
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Country | US
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Telephone | 425-658-3016
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-18-32407
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License Number State | IL
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