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NPI Code Detail

MEDICARE: KELSEY JEAN REDNOUR RBT

MEDICARE: KELSEY JEAN REDNOUR RBT
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1568141729
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY JEAN REDNOUR RBT
Provider Business Mailing Address
First Line : 5220 6TH STREET FRONTAGE RD E STE 1700
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-5771
Country : US
Telephone Number : 217-525-8332
Fax Number : 217-789-1420
Provider Business Practice Location Address
First Line : 4559 BENES AVE
Second Line :
City : GLEN CARBON
State : IL
Zip : 62034-1541
Country : US
Telephone Number : 217-525-8332
Fax Number : 217-789-1420
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2023
Last Update Date : 07/14/2023

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Directions to “ KELSEY JEAN REDNOUR RBT” Practice Location

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