Healthcare Provider Details

I. General information

NPI: 1336104934
Provider Name (Legal Business Name): KYLEE J LADD PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 E OGDEN AVE STE 106
NAPERVILLE IL
60563-2693
US

IV. Provider business mailing address

3832 GRASSMERE RD
NAPERVILLE IL
60564-8234
US

V. Phone/Fax

Practice location:
  • Phone: 331-226-0315
  • Fax: 331-226-0315
Mailing address:
  • Phone: 802-782-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085-005152
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number055-0030279
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: