=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760359715
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYLE KEMLAGE RBT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2025
-----------------------------------------------------
Last Update Date | 10/22/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7522 BIG BEND BLVD
-----------------------------------------------------
City | SAINT LOUIS
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63119-2104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-532-5400
-----------------------------------------------------
Fax | 314-532-5400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 229 AMERISTAR BLVD APT 205
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63301-3538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 314-532-5400
-----------------------------------------------------
Fax | 573-874-1723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106E00000X
-----------------------------------------------------
Taxonomy Name | Assistant Behavior Analyst
-----------------------------------------------------
License Number | RBT-16-26025
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------