Healthcare Provider Details

I. General information

NPI: 1285548677
Provider Name (Legal Business Name): KALAYZA PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W 10TH ST APT 204
INDIANAPOLIS IN
46222-5318
US

IV. Provider business mailing address

1777 W STONES CROSSING RD STE 120
GREENWOOD IN
46143-7899
US

V. Phone/Fax

Practice location:
  • Phone: 463-302-1900
  • Fax:
Mailing address:
  • Phone: 317-960-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: