Provider Demographics
NPI:1689103566
Name:LUDINGTON, KYLA MARIE
Entity Type:Individual
Prefix:MS
First Name:KYLA
Middle Name:MARIE
Last Name:LUDINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:MARIE
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3734 NE PETROSA AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3995
Mailing Address - Country:US
Mailing Address - Phone:206-595-7068
Mailing Address - Fax:
Practice Address - Street 1:3734 NE PETROSA AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3995
Practice Address - Country:US
Practice Address - Phone:206-595-7068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60553320225700000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist