MEDICARE: KAYLA ENNETT PSY.D

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	103T00000X	Psychologist	PSY0006748	CO
2	103T00000X	Psychologist	5549-57	WI
3	103T00000X	Psychologist	14272867-2501	UT

General Provider Information

NPI Number	:	1902336704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA ENNETT PSY.D

Provider Business Mailing Address
First Line	:	10933 TORREYS PEAK WAY
Second Line	:
City	:	PEYTON
State	:	CO
Zip	:	80831-4429
Country	:	US
Telephone Number	:	619-886-0633
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 OFFICE CLUB PT STE 225
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-5016
Country	:	US
Telephone Number	:	619-886-0633
Fax Number	:

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

Provider Enumeration Date	:	06/14/2017
Last Update Date	:	05/21/2026

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