Provider Demographics
NPI:1245774603
Name:MEEK, KAILYN DANYELLE
Entity Type:Individual
Prefix:
First Name:KAILYN
Middle Name:DANYELLE
Last Name:MEEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAILYN
Other - Middle Name:DANYELLE
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:567 BRICKELL ST SE APT 308B
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909-4472
Mailing Address - Country:US
Mailing Address - Phone:321-795-5525
Mailing Address - Fax:
Practice Address - Street 1:567 BRICKELL ST SE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32909-4472
Practice Address - Country:US
Practice Address - Phone:321-795-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-16-25959106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician