Healthcare Provider Details

I. General information

NPI: 1588553291
Provider Name (Legal Business Name): DEZERAE KINDERKNECHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 E 7TH ST
HAYS KS
67601-4152
US

IV. Provider business mailing address

215 E 7TH ST
HAYS KS
67601-4152
US

V. Phone/Fax

Practice location:
  • Phone: 785-628-2871
  • Fax:
Mailing address:
  • Phone: 785-628-2871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: