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NPI Code Detail

MEDICARE: KELSEY PROCTOR

MEDICARE: KELSEY PROCTOR
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
1101Y00000XCounselor
2103K00000XBehavior Analyst

General Provider Information

NPI Number : 1295126555
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY PROCTOR
Provider Business Mailing Address
First Line : 71 STATE ST
Second Line :
City : GUILFORD
State : CT
Zip : 06437-2723
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1250 EXECUTIVE PL STE 201
Second Line :
City : GENEVA
State : IL
Zip : 60134-3805
Country : US
Telephone Number : 815-223-2237
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2015
Last Update Date : 09/24/2019

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Directions to “ KELSEY PROCTOR ” Practice Location

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