Provider Demographics
NPI:1093588394
Name:WHITLATCH, KILEY LYNN
Entity Type:Individual
Prefix:
First Name:KILEY
Middle Name:LYNN
Last Name:WHITLATCH
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 1:1 PIER POINTE ST
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-3569
Mailing Address - Country:US
Mailing Address - Phone:304-830-1274
Mailing Address - Fax:
Practice Address - Street 1:1 PIER POINTE ST
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-3569
Practice Address - Country:US
Practice Address - Phone:304-830-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst