Most Relevant Information
Provider Data
| NPI Number: | 1003440728 |
| Provider Name: | KACEY RUSSELL RBT |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/03/2020 |
| Last Updated: | 02/03/2023 |
Provider Practice Location
9374 OLIVE BLVD STE 101
OLIVETTE
MO
631323253
Practice Location Phone/Fax
| Phone: | 3149322402 |
| Fax: |
Provider Mailing Location
9374 OLIVE BLVD STE 101
OLIVETTE
MO
631323253
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |