MEDICARE: KAYLA LAWLOR

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	103K00000X	Behavior Analyst		AZ

General Provider Information

NPI Number	:	1316601735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA LAWLOR

Provider Business Mailing Address
First Line	:	9307 E MADERO AVE
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85209-1108
Country	:	US
Telephone Number	:	480-773-2075
Fax Number	:

Provider Business Practice Location Address
First Line	:	5656 S POWER RD # 115
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85295-8480
Country	:	US
Telephone Number	:	480-389-4516
Fax Number	:

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

Provider Enumeration Date	:	10/22/2021
Last Update Date	:	10/22/2021

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Directions to “ KAYLA LAWLOR ” Practice Location

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