Provider Demographics
NPI:1275221541
Name:BAIRES, KAYLA DAWNE
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:DAWNE
Last Name:BAIRES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 E BEACON AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:MONTESANO
Mailing Address - State:WA
Mailing Address - Zip Code:98563-9756
Mailing Address - Country:US
Mailing Address - Phone:360-549-6763
Mailing Address - Fax:
Practice Address - Street 1:1504 E BEACON AVE APT 20
Practice Address - Street 2:
Practice Address - City:MONTESANO
Practice Address - State:WA
Practice Address - Zip Code:98563-9756
Practice Address - Country:US
Practice Address - Phone:360-549-6763
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician