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General NPI Number Information
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NPI Number | 1912773581
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Entity Type | Organization
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Legal Business Name | KALEIDOSCOPE CONNECTIONS, PLLC
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Dates
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Enumeration Date | 11/27/2023
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Last Update Date | 11/27/2023
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Provider Practice Location Address
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Address Line | 11301 SE 10TH ST APT 104
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City | VANCOUVER
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State | WA
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Zip | 98664-6119
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Country | US
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Telephone | 949-573-3165
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Fax |
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Provider Business Mailing Address
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Address Line | 11301 SE 10TH ST APT 104
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City | VANCOUVER
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State | WA
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Zip | 98664-6119
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Country | US
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Telephone | 949-573-3165
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Fax |
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Authorized Official
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Title or Position | CEO AND CLINICAL DIRECTOR
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Name | KAITLIN FOX
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Credential | BCBA, LBA
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Telephone | 949-573-3165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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