Provider Demographics
NPI:1043069701
Name:RODE, KELLI (BCBA)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:RODE
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 1:415 DURST BEHRENDS RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-8146
Mailing Address - Country:US
Mailing Address - Phone:830-889-4099
Mailing Address - Fax:
Practice Address - Street 1:1717 E CARY ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7024
Practice Address - Country:US
Practice Address - Phone:804-215-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBACB638741103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst