MEDICARE: KELLY JEAN ARENS WHICKER MA, LCPC, 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
1	101YM0800X	Mental Health Counselor	180004068	IL
2	103K00000X	Behavior Analyst
3	101YP2500X	Professional Counselor	180004068	IL

General Provider Information

NPI Number	:	1295164242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY JEAN ARENS WHICKER MA, LCPC, BCBA

Provider Business Mailing Address
First Line	:	19 COUNTRY PL
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-5311
Country	:	US
Telephone Number	:	812-483-8096
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 COUNTRY PL
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-5311
Country	:	US
Telephone Number	:	812-483-8096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2013
Last Update Date	:	02/07/2022

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