Provider Demographics
NPI:1972004380
Name:DYER, KELSEY L (RBT)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:L
Last Name:DYER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 6TH STREET FRONTAGE RD E STE 1700
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-5771
Mailing Address - Country:US
Mailing Address - Phone:217-525-8332
Mailing Address - Fax:217-789-1420
Practice Address - Street 1:115 ROTTINGHAM CT STE A
Practice Address - Street 2:
Practice Address - City:EDWARDSVILLE
Practice Address - State:IL
Practice Address - Zip Code:62025-3677
Practice Address - Country:US
Practice Address - Phone:866-522-2467
Practice Address - Fax:217-789-1420
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician