Provider Demographics
NPI:1386217628
Name:OWENS, KAYLEE R
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:R
Last Name:OWENS
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 1:25643 GOODWIN RD
Mailing Address - Street 2:
Mailing Address - City:WYOMING
Mailing Address - State:MN
Mailing Address - Zip Code:55092-8324
Mailing Address - Country:US
Mailing Address - Phone:651-728-2095
Mailing Address - Fax:
Practice Address - Street 1:25643 GOODWIN RD
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MN
Practice Address - Zip Code:55092-8324
Practice Address - Country:US
Practice Address - Phone:651-728-2095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician