Provider Demographics
NPI:1790205318
Name:MERRILL, KAYDIE (MS, MED)
Entity Type:Individual
Prefix:MRS
First Name:KAYDIE
Middle Name:
Last Name:MERRILL
Suffix:
Gender:F
Credentials:MS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2458 BEAVER DR
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-5617
Mailing Address - Country:US
Mailing Address - Phone:406-939-5051
Mailing Address - Fax:307-363-4807
Practice Address - Street 1:3907 CHIPPEWA AVE
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6674
Practice Address - Country:US
Practice Address - Phone:406-939-5051
Practice Address - Fax:307-363-4807
Is Sole Proprietor?:No
Enumeration Date:2017-06-24
Last Update Date:2017-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1-16-24761103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst