Provider Demographics
NPI:1326572967
Name:BROMEN, KYLEIGH (BCBA)
Entity Type:Individual
Prefix:
First Name:KYLEIGH
Middle Name:
Last Name:BROMEN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KYLEIGH
Other - Middle Name:
Other - Last Name:HAGOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4545 S 86TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9263
Mailing Address - Country:US
Mailing Address - Phone:515-207-5251
Mailing Address - Fax:
Practice Address - Street 1:4545 S 86TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9263
Practice Address - Country:US
Practice Address - Phone:515-207-5251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1-18-30348103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst