Provider Demographics
NPI:1982373528
Name:WOJCIECHOWSKI, KELLIE (RBT)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:WOJCIECHOWSKI
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 1:4410 MARBURG AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1372
Mailing Address - Country:US
Mailing Address - Phone:219-781-4166
Mailing Address - Fax:
Practice Address - Street 1:925 DUDLEY PIKE
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-8120
Practice Address - Country:US
Practice Address - Phone:859-636-1904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician