Provider Demographics
NPI:1336104934
Name:LADD, KYLEE J (PA)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:J
Last Name:LADD
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:3832 GRASSMERE RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8234
Mailing Address - Country:US
Mailing Address - Phone:708-326-6270
Mailing Address - Fax:708-995-5417
Practice Address - Street 1:260 CREST RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAINT ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9503
Practice Address - Country:US
Practice Address - Phone:802-524-1223
Practice Address - Fax:802-524-1095
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2020-05-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT055-0030279363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT9000230Medicaid
VT9000230Medicaid