Provider Demographics
NPI:1477987832
Name:MCCLELLAN, KALA DABLE (MSE, BCBA)
Entity Type:Individual
Prefix:
First Name:KALA
Middle Name:DABLE
Last Name:MCCLELLAN
Suffix:
Gender:F
Credentials:MSE, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W8057 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:HOLMEN
Mailing Address - State:WI
Mailing Address - Zip Code:54636-9500
Mailing Address - Country:US
Mailing Address - Phone:612-978-3190
Mailing Address - Fax:
Practice Address - Street 1:W8057 MAPLE ST
Practice Address - Street 2:
Practice Address - City:HOLMEN
Practice Address - State:WI
Practice Address - Zip Code:54636-9500
Practice Address - Country:US
Practice Address - Phone:612-978-3190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1-13-13672103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1-13-13672OtherBOARD CERTIFIED BEHAVIOR ANALYST