Provider Demographics
NPI:1144572306
Name:FREI, KYLEA SUE (EDD, BCBA)
Entity Type:Individual
Prefix:DR
First Name:KYLEA
Middle Name:SUE
Last Name:FREI
Suffix:
Gender:F
Credentials:EDD, BCBA
Other - Prefix:
Other - First Name:KYLEA
Other - Middle Name:SUE
Other - Last Name:CORBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 MONTERAY AVE
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2650
Mailing Address - Country:US
Mailing Address - Phone:937-477-6884
Mailing Address - Fax:
Practice Address - Street 1:201 MONTERAY AVE
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:OH
Practice Address - Zip Code:45419-2650
Practice Address - Country:US
Practice Address - Phone:937-477-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1-11-8570103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0003068Medicaid
OH0294053Medicaid