Healthcare Provider Details

I. General information

NPI: 1902435050
Provider Name (Legal Business Name): KAYLYNN CAMERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E CENTRAL AVE
SPOKANE WA
99208-1108
US

IV. Provider business mailing address

1690 HIGGINS RD SE
PORT ORCHARD WA
98366-2928
US

V. Phone/Fax

Practice location:
  • Phone: 360-240-0022
  • Fax:
Mailing address:
  • Phone: 360-551-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: