Provider Demographics
NPI:1538658760
Name:MALONEY, KAYLA (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MALONEY
Suffix:
Gender:F
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 BASSETT DR
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-6569
Mailing Address - Country:US
Mailing Address - Phone:507-429-5018
Mailing Address - Fax:920-857-3366
Practice Address - Street 1:1720 BASSETT DR
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-6569
Practice Address - Country:US
Practice Address - Phone:507-429-5018
Practice Address - Fax:920-857-3366
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WI1-19-39534103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician