Healthcare Provider Details

I. General information

NPI: 1124934351
Provider Name (Legal Business Name): KYLEE NIELSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2532 SANTIAM HWY SE # 114
ALBANY OR
97322-5211
US

IV. Provider business mailing address

2532 SANTIAM HWY SE # 114
ALBANY OR
97322-5211
US

V. Phone/Fax

Practice location:
  • Phone: 541-236-2037
  • Fax: 541-502-3362
Mailing address:
  • Phone: 541-236-2037
  • Fax: 541-502-3362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number10258104
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: