Provider Demographics
NPI:1033485123
Name:DE JONG, KIMBERLY ELLISON (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ELLISON
Last Name:DE JONG
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15905 CHATEAU AVENUE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734
Mailing Address - Country:US
Mailing Address - Phone:240-418-2233
Mailing Address - Fax:301-263-6870
Practice Address - Street 1:15905 CHATEAU AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-2639
Practice Address - Country:US
Practice Address - Phone:240-418-2233
Practice Address - Fax:301-263-6870
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-22
Last Update Date:2014-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst