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General NPI Number Information
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NPI Number | 1689199374
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Entity Type | Individual
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Provider Name | KELLIE ROY
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Gender | Female
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 03/24/2025
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Provider Practice Location Address
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Address Line | 3801 KERN WAY
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City | YAKIMA
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State | WA
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Zip | 98902-6340
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Country | US
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Telephone | 509-574-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CANYON PKWY UNIT A23
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City | SELAH
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State | WA
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Zip | 98942-1281
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Country | US
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Telephone | 509-388-6226
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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 | BA61132172
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License Number State | WA
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