Provider Demographics
NPI:1336572122
Name:GOUDREAU, KELLY H (BCBA)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:H
Last Name:GOUDREAU
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:H
Other - Last Name:STIMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7901 E 88TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1235
Mailing Address - Country:US
Mailing Address - Phone:317-849-5437
Mailing Address - Fax:317-842-5911
Practice Address - Street 1:7901 E 88TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1235
Practice Address - Country:US
Practice Address - Phone:317-849-5437
Practice Address - Fax:317-842-5911
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst