Provider Demographics
NPI:1760920326
Name:RUFFIN, KELSEY ANN (BCBA)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:ANN
Last Name:RUFFIN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5405 MURLAND HOLW
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48383-1347
Mailing Address - Country:US
Mailing Address - Phone:248-755-7846
Mailing Address - Fax:
Practice Address - Street 1:10435 ORTONVILLE RD STE A
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-1979
Practice Address - Country:US
Practice Address - Phone:248-755-7846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-03
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1-16-24410103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1-16-24410OtherBCBA