MEDICARE: HAYLEE JEAN KATHERINE KENJOSIAN RBT

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	106S00000X	Behavior Technician	RBT-23-252817	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447964804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYLEE JEAN KATHERINE KENJOSIAN RBT

Provider Business Mailing Address
First Line	:	1081 HOSBINE ST SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-3870
Country	:	US
Telephone Number	:	321-424-4379
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 SARNO ROAD
Second Line	:	SUITE 114
City	:	PALM BAY
State	:	FL
Zip	:	32909-3870
Country	:	US
Telephone Number	:	321-451-5825
Fax Number	:

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

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	04/17/2026

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