Provider Demographics
NPI:1326804410
Name:LEDLOW, KAILEY GRACE
Entity Type:Individual
Prefix:
First Name:KAILEY
Middle Name:GRACE
Last Name:LEDLOW
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 1:6440 LAKE BURDEN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-5643
Mailing Address - Country:US
Mailing Address - Phone:904-238-4705
Mailing Address - Fax:
Practice Address - Street 1:3200 S HIAWASSEE RD STE 203
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6317
Practice Address - Country:US
Practice Address - Phone:407-542-2506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1055981106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician