Provider Demographics
NPI:1295210326
Name:LUELL, KALLY K (BCBA)
Entity Type:Individual
Prefix:
First Name:KALLY
Middle Name:K
Last Name:LUELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KALLY
Other - Middle Name:K
Other - Last Name:ANGELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1210 FOURIER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1969
Mailing Address - Country:US
Mailing Address - Phone:608-662-9327
Mailing Address - Fax:608-662-9041
Practice Address - Street 1:2125 HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4562
Practice Address - Country:US
Practice Address - Phone:715-832-2233
Practice Address - Fax:715-833-1666
Is Sole Proprietor?:No
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst