Healthcare Provider Details

I. General information

NPI: 1265933782
Provider Name (Legal Business Name): KAYLEE WITRAGO MA, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 N FRESNO ST STE 102
FRESNO CA
93710-5280
US

IV. Provider business mailing address

5507 E NEVADA AVE
FRESNO CA
93727-3355
US

V. Phone/Fax

Practice location:
  • Phone: 559-650-7224
  • Fax:
Mailing address:
  • Phone: 661-428-3872
  • Fax: 866-500-2186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: