Provider Demographics
NPI:1255666806
Name:KELSO, JUDITH ANNE (BCBA)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:ANNE
Last Name:KELSO
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 1:1275 S PATRICK DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3963
Mailing Address - Country:US
Mailing Address - Phone:321-779-0213
Mailing Address - Fax:321-773-0497
Practice Address - Street 1:1275 S PATRICK DR
Practice Address - Street 2:SUITE C
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-3963
Practice Address - Country:US
Practice Address - Phone:321-779-0213
Practice Address - Fax:321-773-0497
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst