Provider Demographics
NPI:1689230229
Name:DOYLE, KELLY ROSE (BCBA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ROSE
Last Name:DOYLE
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 1:1950 N LOGAN ST APT 409
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1175
Mailing Address - Country:US
Mailing Address - Phone:210-749-2705
Mailing Address - Fax:
Practice Address - Street 1:1950 N LOGAN ST APT 409
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-1175
Practice Address - Country:US
Practice Address - Phone:210-749-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-18
Last Update Date:2019-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst