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General NPI Number Information
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NPI Number | 1508376773
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Entity Type | Individual
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Provider Name | KELLY JONARD
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Gender | Female
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Dates
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Enumeration Date | 10/02/2017
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Last Update Date | 06/14/2024
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Provider Practice Location Address
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Address Line | 313 E BROAD ST STE 152
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City | RICHMOND
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State | VA
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Zip | 23219-1737
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Country | US
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Telephone | 855-295-3276
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Fax | 888-588-2752
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Provider Business Mailing Address
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Address Line | 1333 S MAYFLOWER AVE STE 220
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City | MONROVIA
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State | CA
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Zip | 91016-5239
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Country | US
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Telephone | 818-241-6780
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Fax | 888-588-2752
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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 | 1-20-42038
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 0133003621
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License Number State | VA
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