Provider Demographics
NPI:1972228906
Name:LUDLOW, WILLIAM KEVIN JR
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:KEVIN
Last Name:LUDLOW
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3416 S DIXON RD STE B
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-5644
Mailing Address - Country:US
Mailing Address - Phone:765-387-3347
Mailing Address - Fax:
Practice Address - Street 1:3416 S DIXON RD STE B
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-5644
Practice Address - Country:US
Practice Address - Phone:765-387-3347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
INRBT-22-238327OtherBEHAVIOR ANALYST CERTIFICATION BOARD