Healthcare Provider Details

I. General information

NPI: 1619573821
Provider Name (Legal Business Name): KAYLA POWERS CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2020
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SPENCER ST
APPLETON WI
54914-9106
US

IV. Provider business mailing address

4650 W SPENCER ST
APPLETON WI
54914-9106
US

V. Phone/Fax

Practice location:
  • Phone: 920-903-1060
  • Fax: 920-903-1060
Mailing address:
  • Phone: 920-903-1060
  • Fax: 920-903-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11134-123
License Number StateWI

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: