MEDICARE: MISS KAYLA LYNN GOLDIN B.S.

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	11624031	MI

General Provider Information

NPI Number	:	1649668237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KAYLA LYNN GOLDIN B.S.

Provider Business Mailing Address
First Line	:	38468 ALBERT BLVD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48036-3201
Country	:	US
Telephone Number	:	248-513-0905
Fax Number	:

Provider Business Practice Location Address
First Line	:	38468 ALBERT BLVD
Second Line	:
City	:	CLINTON TWP
State	:	MI
Zip	:	48036-3201
Country	:	US
Telephone Number	:	248-513-0905
Fax Number	:

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

Provider Enumeration Date	:	01/05/2015
Last Update Date	:	02/17/2017

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