MEDICARE: KAITLIN KESLER BCBA

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	101Y00000X	Counselor
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1528448669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN KESLER BCBA

Provider Business Mailing Address
First Line	:	8100 M4 WYOMING BLVD STE 406
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87113-1861
Country	:	US
Telephone Number	:	505-828-3837
Fax Number	:	877-828-3837

Provider Business Practice Location Address
First Line	:	1817 WELLSPRING AVE SE STE D
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-4956
Country	:	US
Telephone Number	:	505-828-3837
Fax Number	:	877-828-1550

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

Provider Enumeration Date	:	06/03/2015
Last Update Date	:	12/28/2018

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