Provider Demographics
NPI:1598108599
Name:EPPERLEY, KELLY ERIN (BCBA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ERIN
Last Name:EPPERLEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:ERIN
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:11859 PRESLEY CIR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-2193
Mailing Address - Country:US
Mailing Address - Phone:708-638-9049
Mailing Address - Fax:
Practice Address - Street 1:452 N EOLA RD
Practice Address - Street 2:SUITE A
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60502-9612
Practice Address - Country:US
Practice Address - Phone:708-638-9049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-13-12844103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst