Provider Demographics
NPI:1689376121
Name:WRIGHTSMAN, KAYLEE (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:WRIGHTSMAN
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 1:5391 THORNAPPLE LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-3462
Mailing Address - Country:US
Mailing Address - Phone:765-227-7274
Mailing Address - Fax:
Practice Address - Street 1:80 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5152
Practice Address - Country:US
Practice Address - Phone:765-448-1758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-23-63966103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst