Provider Demographics
NPI:1508237322
Name:BOUDEWYN, KAILA (BA)
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:BOUDEWYN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 BIG PINE DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-8778
Mailing Address - Country:US
Mailing Address - Phone:727-710-9380
Mailing Address - Fax:
Practice Address - Street 1:2530 BIG PINE DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-8778
Practice Address - Country:US
Practice Address - Phone:727-710-9380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker