Healthcare Provider Details

I. General information

NPI: 1760302277
Provider Name (Legal Business Name): KAIYA HOLLISTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 EXECUTIVE PL STE 201
GENEVA IL
60134-3805
US

IV. Provider business mailing address

723 PALACE ST
AURORA IL
60506-3019
US

V. Phone/Fax

Practice location:
  • Phone: 815-223-2337
  • Fax: 815-327-3440
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2828994
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: