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NPI Code Detail

MEDICARE: MRS. ELIZABETH ROXANNE KELSO SIX BCBA

MEDICARE: MRS. ELIZABETH ROXANNE KELSO SIX BCBA
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 Analyst1-18-30563IL

General Provider Information

NPI Number : 1114405479
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELIZABETH ROXANNE KELSO SIX BCBA
Provider Business Mailing Address
First Line : 2339 N CALIFORNIA AVE UNIT 47949
Second Line :
City : CHICAGO
State : IL
Zip : 60647-0360
Country : US
Telephone Number : 773-595-6786
Fax Number : 773-305-8082
Provider Business Practice Location Address
First Line : 3048 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60618-6624
Country : US
Telephone Number : 773-595-6786
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/30/2018
Last Update Date : 04/01/2019

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