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NPI Code Detail

MEDICARE: KELLY KUENNEN

MEDICARE: KELLY KUENNEN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063902450
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY KUENNEN
Provider Business Mailing Address
First Line : 10450 72ND AVE
Second Line :
City : PLEASANT PRAIRIE
State : WI
Zip : 53158-2911
Country : US
Telephone Number : 262-657-7453
Fax Number : 262-671-5013
Provider Business Practice Location Address
First Line : 10450 72ND AVE
Second Line :
City : PLEASANT PRAIRIE
State : WI
Zip : 53158-2911
Country : US
Telephone Number : 262-657-7453
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2018
Last Update Date : 05/11/2018

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Directions to “ KELLY KUENNEN ” Practice Location

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