Provider Demographics
NPI:1275147183
Name:BALAUN, KYLIE H H (MS, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:KYLIE
Middle Name:H H
Last Name:BALAUN
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33693 HIBERNIA ST
Mailing Address - Street 2:
Mailing Address - City:FRONTENAC
Mailing Address - State:MN
Mailing Address - Zip Code:55026-1002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:33693 HIBERNIA ST
Practice Address - Street 2:
Practice Address - City:FRONTENAC
Practice Address - State:MN
Practice Address - Zip Code:55026-1002
Practice Address - Country:US
Practice Address - Phone:209-689-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-47313103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst