Kelly Jo Mikelson

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

2630 W Rumble Rd
Modesto, CA 95350-0155

Phone

(209) 271-9015

NPI assigned

Oct 12, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1570838400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1962044834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 SPINDALE DR",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953571566",
            "telephone_number": "209-271-9015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2630 W RUMBLE RD",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953500155",
            "telephone_number": "209-271-9015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MIKELSON",
        "first_name": "KELLY",
        "middle_name": "JO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-12",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "1-855-950-0002",
            "affiliation": "N",
            "endpointDescription": "FAX",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "Nevada Behavior",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Nevada Behavior",
            "address_1": "1900 Dennis Flat Road",
            "city": "Deeth",
            "state": "NV",
            "country_code": "US",
            "postal_code": "89823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Lauren E Miklose
• Kristi Lynn Miklusicak, M.A., B.I.C.M.
• Ahryanna Miles
• Ke Araha Deshaney Miles
• Yuleysi Millan Zamora

• Behavior Technician in Modesto, CA
• Providers in Modesto, CA by specialty
• Behavior Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.