Healthcare Provider Details

I. General information

NPI: 1679175160
Provider Name (Legal Business Name): KAYLEE KING BCABA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 BOULDER HILL PASS
MONTGOMERY IL
60538-1911
US

IV. Provider business mailing address

89 BOULDER HILL PASS
MONTGOMERY IL
60538-1911
US

V. Phone/Fax

Practice location:
  • Phone: 773-260-2898
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-2829927
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: