Provider Demographics
NPI:1003267618
Name:FELLER, KINSEY ANNE (BCBA)
Entity Type:Individual
Prefix:
First Name:KINSEY
Middle Name:ANNE
Last Name:FELLER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KINSEY
Other - Middle Name:ANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:2430 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-1539
Mailing Address - Country:US
Mailing Address - Phone:563-271-6036
Mailing Address - Fax:
Practice Address - Street 1:2430 6TH AVE
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-1539
Practice Address - Country:US
Practice Address - Phone:309-764-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst