Healthcare Provider Details

I. General information

NPI: 1942094586
Provider Name (Legal Business Name): KYLIE ELIZABETH IWIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2025
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13333 PALMDALE RD
VICTORVILLE CA
92392-9364
US

IV. Provider business mailing address

290 N D ST STE 700
SAN BERNARDINO CA
92401-1705
US

V. Phone/Fax

Practice location:
  • Phone: 760-487-3600
  • Fax:
Mailing address:
  • Phone: 909-963-5355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: