Provider Demographics
NPI:1013568443
Name:PEARSON, KYLEE N (BCBA)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:N
Last Name:PEARSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N HIGH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-3684
Mailing Address - Country:US
Mailing Address - Phone:317-731-7777
Mailing Address - Fax:
Practice Address - Street 1:618 N HIGH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-3684
Practice Address - Country:US
Practice Address - Phone:317-731-7777
Practice Address - Fax:317-942-0863
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-19-37297103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst