Healthcare Provider Details

I. General information

NPI: 1992669147
Provider Name (Legal Business Name): KALEIGH WANDELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 FERRY ST FL 2
HAVERHILL MA
01835-7442
US

IV. Provider business mailing address

3 FERRY ST FL 2
HAVERHILL MA
01835-7442
US

V. Phone/Fax

Practice location:
  • Phone: 351-222-8064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: