Healthcare Provider Details

I. General information

NPI: 1093647588
Provider Name (Legal Business Name): KAYLA GILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E NORTH ST
ELIDA OH
45807-1098
US

IV. Provider business mailing address

401 E NORTH ST
ELIDA OH
45807-1098
US

V. Phone/Fax

Practice location:
  • Phone: 419-338-6840
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.02282
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: