Healthcare Provider Details

I. General information

NPI: 1497296792
Provider Name (Legal Business Name): JODY L KYLE BCBA, LBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 04/09/2021
Certification Date: 04/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14733 CLAYTON RD
BALLWIN MO
63011-2660
US

IV. Provider business mailing address

1690 TROTTER WAY
FLORISSANT MO
63033-2531
US

V. Phone/Fax

Practice location:
  • Phone: 314-339-7732
  • Fax:
Mailing address:
  • Phone: 636-697-7437
  • Fax: 314-845-3901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2019003795
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-15-08251
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: