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General NPI Number Information
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NPI Number | 1760303507
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Entity Type | Individual
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Provider Name | KYLIE POLANCO
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Gender | Female
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Dates
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Enumeration Date | 07/24/2026
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Last Update Date | 07/24/2026
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Provider Practice Location Address
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Address Line | 110 ENTERPRISE DR
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-9503
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Country | US
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Telephone | 574-387-4313
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Fax | 574-204-2868
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Provider Business Mailing Address
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Address Line | 215 RED COACH DR
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City | MISHAWAKA
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State | IN
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Zip | 46545-8307
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Country | US
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Telephone | 574-387-4313
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Fax | 574-204-2868
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | RBT-24-374503
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License Number State | NC
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