Provider Demographics
NPI:1225482862
Name:RYAN, KYLIE ANN (BCBA)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:ANN
Other - Last Name:BAIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4721 S CLIFF AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6969
Mailing Address - Country:US
Mailing Address - Phone:816-608-1958
Mailing Address - Fax:
Practice Address - Street 1:4721 S CLIFF AVE STE 103
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6969
Practice Address - Country:US
Practice Address - Phone:816-608-1958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
RBT-19-82078106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst