Kellie Bohlke, BCBA
Behavior Analyst in Santa Cruz, CA. Individual provider (NPI-1).
NPI number1578032629
StatusActive
Last updated in NPPESDec 18, 2024
Details
- NPI
- 1578032629
- Entity type
- Individual (NPI-1)
- Name
- Kellie Bohlke
- Credential
- BCBA
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Nov 19, 2018
- Certification date
- Dec 18, 2024
- Last updated
- Dec 18, 2024
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 103K00000X | Behavior Analyst | 12041212 | CA | Yes |
Practice location
521 38th AveSanta Cruz, CA 95062-5524
Phone 952-457-3963
Mailing address
521 38th AveSanta Cruz, CA 95062-5524
Phone 952-457-3963
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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