Provider Demographics
NPI:1033894753
Name:BREEDLOVE, KAYLA LOUISE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:LOUISE
Last Name:BREEDLOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4840 RANCH DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-4148
Mailing Address - Country:US
Mailing Address - Phone:626-736-3434
Mailing Address - Fax:
Practice Address - Street 1:4840 RANCH DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4148
Practice Address - Country:US
Practice Address - Phone:626-736-3434
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician