MEDICARE: HANNAH KYLLO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	1524-2-1-26A	ND

General Provider Information

NPI Number	:	1285032599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH KYLLO

Provider Business Mailing Address
First Line	:	4143 26TH AVE S STE 100
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-7919
Country	:	US
Telephone Number	:	701-566-0204
Fax Number	:

Provider Business Practice Location Address
First Line	:	4143 26TH AVE S STE 100
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-7919
Country	:	US
Telephone Number	:	701-566-0204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2014
Last Update Date	:	02/04/2026

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Directions to “ HANNAH KYLLO ” Practice Location

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