Provider Demographics
NPI:1225484439
Name:SCHUKNECHT, KELLY A (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:SCHUKNECHT
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:A
Other - Last Name:MALETTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:961 SALTCOATS DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6095
Mailing Address - Country:US
Mailing Address - Phone:951-227-2207
Mailing Address - Fax:
Practice Address - Street 1:961 SALTCOATS DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508-6095
Practice Address - Country:US
Practice Address - Phone:951-227-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-15-18027103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst