Provider Demographics
NPI:1518725456
Name:JEWETT, KALEIGH NICOLE
Entity Type:Individual
Prefix:
First Name:KALEIGH
Middle Name:NICOLE
Last Name:JEWETT
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 1:4628 QUEENS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-3232
Mailing Address - Country:US
Mailing Address - Phone:326-202-8872
Mailing Address - Fax:
Practice Address - Street 1:2522 NUTTER PARK DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45434-3500
Practice Address - Country:US
Practice Address - Phone:937-306-8811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician