Healthcare Provider Details

I. General information

NPI: 1801659404
Provider Name (Legal Business Name): KAILEN RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 N GREENFIELD RD STE 110
GILBERT AZ
85234-5062
US

IV. Provider business mailing address

726 N GREENFIELD RD STE 110
GILBERT AZ
85234-5062
US

V. Phone/Fax

Practice location:
  • Phone: 602-535-8341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-72047
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-298466
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: