MEDICARE: SKYLAR KISSAM BCBA, LBA, M.ED

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1295268787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SKYLAR KISSAM BCBA, LBA, M.ED

Provider Business Mailing Address
First Line	:	27777 INKSTER RD STE 100
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48334-5312
Country	:	US
Telephone Number	:	855-772-8847
Fax Number	:

Provider Business Practice Location Address
First Line	:	2701 PARK CENTER DR APT B712
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22302-1491
Country	:	US
Telephone Number	:	757-597-1600
Fax Number	:

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

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	04/05/2024

Similar Medicare Providers

1861987562 — GRETCHEN BOCK LMT
Practice Location Address:

1491 NE ALEXANDRIA PL
HILLSBORO, OR
97124-4135

Practice Phone: 971-394-9489
Practice Fax:

1407626377 — AMELIA MORTON
Practice Location Address:

3610 KING ST STE D
ALEXANDRIA, VA
22302-1908

Practice Phone: 855-910-3278
Practice Fax:

1073383261 — MEDSTAR URGENT CARE LLC
Practice Location Address:

3610D KING ST
ALEXANDRIA, VA
22302-1908

Practice Phone: 703-845-2815
Practice Fax:

1760023865 — AVAM CANCER & BLOOD SPECIALISTS, LLC
Practice Location Address:

3541 W BRADDOCK RD STE 150
ALEXANDRIA, VA
22302-1923

Practice Phone: 703-574-0708
Practice Fax: 703-574-0709

1164447264 — LAURA L EVANS NURSE PRACTITIONER
Practice Location Address:

3543 W BRADDOCK RD
ALEXANDRIA, VA
22302-1900

Practice Phone: 703-567-4104
Practice Fax: 949-703-7648

1083561963 — CONNOR M HOLLENBECK DC
Practice Location Address:

3543 W BRADDOCK RD
ALEXANDRIA, VA
22302-1900

Practice Phone: 703-952-5652
Practice Fax:

Directions to “ SKYLAR KISSAM BCBA, LBA, M.ED” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.