Provider Demographics
NPI:1558043380
Name:RENO, KAYLA DAWN (MSW INTERN)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:DAWN
Last Name:RENO
Suffix:
Gender:F
Credentials:MSW INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 DARTMOUTH DR SE APT D
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2261
Mailing Address - Country:US
Mailing Address - Phone:505-333-9042
Mailing Address - Fax:505-796-5475
Practice Address - Street 1:120 DARTMOUTH DR SE APT D
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-2261
Practice Address - Country:US
Practice Address - Phone:505-333-9042
Practice Address - Fax:505-796-5475
Is Sole Proprietor?:No
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program