Provider Demographics
NPI:1407345580
Name:ROWLEN, KELLEY (RBT-18-50257)
Entity Type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:ROWLEN
Suffix:
Gender:F
Credentials:RBT-18-50257
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8039 KNOX AVE APT 1S
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-3164
Mailing Address - Country:US
Mailing Address - Phone:847-324-9304
Mailing Address - Fax:
Practice Address - Street 1:8039 KNOX AVE APT 1S
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-3164
Practice Address - Country:US
Practice Address - Phone:847-324-9304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL18-50257106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician