Provider Demographics
NPI:1043793573
Name:PLEDGER, KAYLI ELYSE (BCBA)
Entity Type:Individual
Prefix:
First Name:KAYLI
Middle Name:ELYSE
Last Name:PLEDGER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:300 INTERNATIONAL PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5028
Mailing Address - Country:US
Mailing Address - Phone:866-610-0580
Mailing Address - Fax:407-588-6294
Practice Address - Street 1:137 JOHNSON FERRY RD STE 2170
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4948
Practice Address - Country:US
Practice Address - Phone:470-648-0510
Practice Address - Fax:470-317-2127
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-19-37706103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst