Provider Demographics
NPI:1114580123
Name:KEPSON, KYLA CATHERINE (LSW)
Entity Type:Individual
Prefix:
First Name:KYLA
Middle Name:CATHERINE
Last Name:KEPSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:CATHERINE
Other - Last Name:KEARNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:6227 STEED WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-2927
Mailing Address - Country:US
Mailing Address - Phone:719-360-6076
Mailing Address - Fax:
Practice Address - Street 1:2210 E LA SALLE ST STE 224
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-2303
Practice Address - Country:US
Practice Address - Phone:719-360-6076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0009921838104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker