Provider Demographics
NPI:1295113603
Name:KALLES, JEFFREY (MS, BCBA)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:KALLES
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 E ROWAN AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1200
Mailing Address - Country:US
Mailing Address - Phone:509-844-2429
Mailing Address - Fax:509-319-2338
Practice Address - Street 1:318 E ROWAN AVE STE 201
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1200
Practice Address - Country:US
Practice Address - Phone:509-844-2429
Practice Address - Fax:509-319-2338
Is Sole Proprietor?:No
Enumeration Date:2015-05-18
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst