Healthcare Provider Details

I. General information

NPI: 1487223046
Provider Name (Legal Business Name): KAYLA NICOLE PATTERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6860 N FRONTAGE RD STE A
BURR RIDGE IL
60527-7828
US

IV. Provider business mailing address

732 N 2ND AVE
VILLA PARK IL
60181-1462
US

V. Phone/Fax

Practice location:
  • Phone: 331-210-9210
  • Fax:
Mailing address:
  • Phone: 574-780-7108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: