Provider Demographics
NPI:1578226403
Name:RISENHUBER, KAYLEY MARIE
Entity Type:Individual
Prefix:
First Name:KAYLEY
Middle Name:MARIE
Last Name:RISENHUBER
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 1:487 N 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353-9749
Mailing Address - Country:US
Mailing Address - Phone:509-551-9352
Mailing Address - Fax:
Practice Address - Street 1:487 N 58TH AVE
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-9749
Practice Address - Country:US
Practice Address - Phone:509-551-9352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty