Provider Demographics
NPI:1881164838
Name:STRACHAN, KELSEY ANGELA (M S, BCBA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANGELA
Last Name:STRACHAN
Suffix:
Gender:F
Credentials:M S, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3678 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-9366
Mailing Address - Country:US
Mailing Address - Phone:920-636-6626
Mailing Address - Fax:
Practice Address - Street 1:232 W WATER ST
Practice Address - Street 2:
Practice Address - City:BRILLION
Practice Address - State:WI
Practice Address - Zip Code:54110-1255
Practice Address - Country:US
Practice Address - Phone:920-524-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI268-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst