Healthcare Provider Details

I. General information

NPI: 1457271249
Provider Name (Legal Business Name): KAYLA MARIE MYRVOLD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 HIGHWAY 7
ST LOUIS PARK MN
55426-4223
US

IV. Provider business mailing address

710 HERITAGE BLVD NW APT 108
ISANTI MN
55040-7007
US

V. Phone/Fax

Practice location:
  • Phone: 952-814-0207
  • 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: