MEDICARE: KAYLA COLEMAN BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-19-36471	CA

General Provider Information

NPI Number	:	1265978027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA COLEMAN BCBA

Provider Business Mailing Address
First Line	:	1005 BLUE RAVINE RD APT 237
Second Line	:
City	:	FOLSOM
State	:	CA
Zip	:	95630-3800
Country	:	US
Telephone Number	:	530-515-6091
Fax Number	:

Provider Business Practice Location Address
First Line	:	1478 STONE POINT DR STE 200
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-2869
Country	:	US
Telephone Number	:	916-771-7444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	01/28/2025

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