Provider Demographics
NPI:1811540933
Name:JANKOWSKI, KAYLI CASEY
Entity Type:Individual
Prefix:MISS
First Name:KAYLI
Middle Name:CASEY
Last Name:JANKOWSKI
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 1:722 E MAIN ST APT B
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-2736
Mailing Address - Country:US
Mailing Address - Phone:559-776-7607
Mailing Address - Fax:
Practice Address - Street 1:722 E MAIN ST APT B
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2736
Practice Address - Country:US
Practice Address - Phone:559-776-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18219115520Medicaid