Healthcare Provider Details

I. General information

NPI: 1306757729
Provider Name (Legal Business Name): KAYLEE HARDIN TCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 W BROADWAY
COUNCIL BLUFFS IA
51501-3814
US

IV. Provider business mailing address

1750 W BROADWAY
COUNCIL BLUFFS IA
51501-3814
US

V. Phone/Fax

Practice location:
  • Phone: 712-215-6588
  • Fax: 712-322-9585
Mailing address:
  • Phone: 712-435-2791
  • Fax: 712-322-9585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT25095
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: