Provider Demographics
NPI:1225675069
Name:WININGS, KYLE
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:WININGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9145 SW 91ST AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6854
Mailing Address - Country:US
Mailing Address - Phone:541-556-2134
Mailing Address - Fax:
Practice Address - Street 1:9145 SW 91ST AVE APT 6
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-6854
Practice Address - Country:US
Practice Address - Phone:541-556-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-27
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician