Provider Demographics
NPI:1821550435
Name:WILEY, CHKYIAH
Entity Type:Individual
Prefix:
First Name:CHKYIAH
Middle Name:
Last Name:WILEY
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 1:1515 E TROPICANA AVE STE 375
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6520
Mailing Address - Country:US
Mailing Address - Phone:702-909-8900
Mailing Address - Fax:702-909-8905
Practice Address - Street 1:1515 E TROPICANA AVE STE 375
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6520
Practice Address - Country:US
Practice Address - Phone:702-909-8900
Practice Address - Fax:702-909-8905
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner