Provider Demographics
NPI:1922344944
Name:SKIBA, KELLI ANNE (MS ED, BCBA)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:ANNE
Last Name:SKIBA
Suffix:
Gender:F
Credentials:MS ED, BCBA
Other - Prefix:MS
Other - First Name:KELLI
Other - Middle Name:ANNE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-2108
Mailing Address - Country:US
Mailing Address - Phone:508-481-1015
Mailing Address - Fax:
Practice Address - Street 1:33 TURNPIKE RD
Practice Address - Street 2:
Practice Address - City:SOUTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01772-2108
Practice Address - Country:US
Practice Address - Phone:508-481-1015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-19
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11623143103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst