Provider Demographics
NPI:1043742240
Name:UKEN, KAELYN
Entity Type:Individual
Prefix:
First Name:KAELYN
Middle Name:
Last Name:UKEN
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 1:1682 SPRUCEMONT ST
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-1769
Mailing Address - Country:US
Mailing Address - Phone:775-682-0425
Mailing Address - Fax:
Practice Address - Street 1:3416 GONI RD # D132
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-8008
Practice Address - Country:US
Practice Address - Phone:702-486-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician