Provider Demographics
NPI:1093438749
Name:YUSWARDY, KAYTHLIN ANGELIN
Entity Type:Individual
Prefix:
First Name:KAYTHLIN
Middle Name:ANGELIN
Last Name:YUSWARDY
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 1:480 E BROADWAY APT 1017
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5492
Mailing Address - Country:US
Mailing Address - Phone:503-830-8618
Mailing Address - Fax:
Practice Address - Street 1:2508 WILLAKENZIE RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4805
Practice Address - Country:US
Practice Address - Phone:503-927-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician